Healthcare Provider Details

I. General information

NPI: 1447576806
Provider Name (Legal Business Name): MATTHEW LOUIS ELTGROTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2010
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-4661
US

IV. Provider business mailing address

2434 GREENS AVE
HENDERSON NV
89014-3778
US

V. Phone/Fax

Practice location:
  • Phone: 702-707-1500
  • Fax: 725-291-4848
Mailing address:
  • Phone: 530-228-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16338
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number16338
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: