MEDICARE: RICHARD MATTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	4301039400	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00396831	OTHER	KY	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	300F362430	OTHER	MI	BCBSM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073573481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD MATTER

Provider Business Mailing Address
First Line	:	870 CORPORATE DR
Second Line	:	STE. 400
City	:	LEXINGTON
State	:	KY
Zip	:	40503-5416
Country	:	US
Telephone Number	:	859-277-9436
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 BOB O LINK DR
Second Line	:	STE 120
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3759
Country	:	US
Telephone Number	:	859-277-3737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	01/29/2013

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Directions to “ RICHARD MATTER ” Practice Location

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