Healthcare Provider Details

I. General information

NPI: 1336250315
Provider Name (Legal Business Name): MATTHEW J PIERZALA DO PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6572 MIDLAND TRAIL RD
ASHLAND KY
41102-9286
US

IV. Provider business mailing address

6572 MIDLAND TRAIL RD
ASHLAND KY
41102-9286
US

V. Phone/Fax

Practice location:
  • Phone: 606-928-7755
  • Fax: 606-928-0052
Mailing address:
  • Phone: 606-928-7755
  • Fax: 606-928-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberKY02941
License Number StateKY

VIII. Authorized Official

Name: LORI K MILLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 606-928-7755