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General NPI Number Information
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NPI Number | 1316268774
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Entity Type | Individual
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Provider Name | MATTHEW MONROE WYATT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 251 E HURON ST GALTER 3-150
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City | CHICAGO
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State | IL
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Zip | 60611-2908
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Country | US
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Telephone | 312-926-8105
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Fax |
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Provider Business Mailing Address
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Address Line | MAIL STOP 1034 3901 RAINBOW ROAD
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City | KANSAS CITY
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State | KS
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Zip | 66160
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Country | US
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Telephone | 913-588-6670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 125058593
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 04-37884
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License Number State | KS
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