Individual
BRUCE H MATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
705 RILEY HOSPITAL DR, SUITE 0860, INDIANAPOLIS, IN 46202-5128
(317) 944-8620
(317) 944-8080
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01037542A
IN
207YP0228X
Pediatric Otolaryngology Physician
Primary
01037542A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000083127
ANTHEM PTAN
IN
05
—
100320610
—
IN
01
—
1102504467
ANTHEM PTAN
IN
Enumeration date
07/10/2006
Last updated
04/14/2025
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