Healthcare Provider Details

I. General information

NPI: 1164825410
Provider Name (Legal Business Name): NIGEL SHAUN MATTHEWS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5211
US

IV. Provider business mailing address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5211
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-7433
  • Fax:
Mailing address:
  • Phone: 317-278-3699
  • Fax: 317-274-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberLDF200013
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: