Individual
DR. PATRICK M MATTHIESSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1009 NEW MOODY LN, LA GRANGE, KY 40031-9142
(502) 222-8503
Mailing address
5200 COMMERCE CROSSINGS DR FL 3, LOUISVILLE, KY 40229-2182
(502) 253-4900
(502) 489-5750
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01074910A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201274940
—
IN
01
—
50084197
PASSPORT
KY
05
—
7100347060
—
KY
01
—
7494410
AETNA
IN
01
—
915174
ANTHEM
IN
Enumeration date
10/06/2005
Last updated
12/12/2022
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