Provider Demographics
NPI:1255698783
Name:MATUSHIN, ELYCIA R (MD)
Entity type:Individual
Prefix:DR
First Name:ELYCIA
Middle Name:R
Last Name:MATUSHIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:800 FREEPORT AVE NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2723
Mailing Address - Country:US
Mailing Address - Phone:763-581-5200
Mailing Address - Fax:763-581-5201
Practice Address - Street 1:1020 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2504
Practice Address - Country:US
Practice Address - Phone:612-302-8200
Practice Address - Fax:612-302-8275
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MN56637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine