Individual
DR. PATRICK M MATTHIESSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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