MEDICARE: MATTHEW LOUIS ELTGROTH 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
1	2085R0202X	Diagnostic Radiology Physician	16338	NV
2	2085R0204X	Vascular & Interventional Radiology Physician	16338	NV

General Provider Information

NPI Number	:	1447576806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW LOUIS ELTGROTH MD

Provider Business Mailing Address
First Line	:	2434 GREENS AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-3778
Country	:	US
Telephone Number	:	530-228-5771
Fax Number	:

Provider Business Practice Location Address
First Line	:	2980 W HORIZON RIDGE PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4661
Country	:	US
Telephone Number	:	702-707-1500
Fax Number	:	725-291-4848

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

Provider Enumeration Date	:	04/10/2010
Last Update Date	:	06/01/2026

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