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NPI Code Detail

MEDICARE: MATTHEW PELSON PARTAIN MD

MEDICARE: MATTHEW PELSON PARTAIN MD
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
1207Y00000XOtolaryngology Physician01085840AIN
2390200000XStudent in an Organized Health Care Education/Training Program
3207YP0228XPediatric Otolaryngology Physician01085840AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000001570407OTHERINANTHEM PTAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174917280
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW PELSON PARTAIN MD
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 705 RILEY HOSPITAL DR STE 2240
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5109
Country : US
Telephone Number : 317-944-8620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2015
Last Update Date : 04/11/2025

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