Individual
MATTHEW G CANTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01064810A
IN
207RC0000X
Cardiovascular Disease Physician
35015
SC
207RI0011X
Interventional Cardiology Physician
Primary
35015
SC
208M00000X
Hospitalist Physician
01064810A
IN
390200000X
Student in an Organized Health Care Education/Training Program
01064810A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000615180
ANTHEM BCBS
IN
05
—
200919560
—
IN
05
—
350159
—
SC
Enumeration date
04/16/2007
Last updated
05/17/2023
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