Healthcare Provider Details

I. General information

NPI: 1750674222
Provider Name (Legal Business Name): MATTHEW DONALD KANGAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 WOLF RIVER BLVD
GERMANTOWN TN
38138-1725
US

IV. Provider business mailing address

7960 WOLF RIVER BLVD
GERMANTOWN TN
38138-1725
US

V. Phone/Fax

Practice location:
  • Phone: 901-587-4700
  • Fax:
Mailing address:
  • Phone: 901-587-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number54762
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number54762
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: