Individual
MATTHEW GREGORY YANTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2944 BRECKENRIDGE LN, LOUISVILLE, KY 40220-1409
(502) 893-0159
(502) 893-0159
Mailing address
2944 BRECKENRIDGE LN, LOUISVILLE, KY 40220-1409
(502) 893-0159
(502) 312-3884
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01078700A
IN
207Y00000X
Otolaryngology Physician
Primary
50401
KY
207Y00000X
Otolaryngology Physician
BP10044563
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01078700A
LICENSE
IN
01
—
265400015
MEDICARE
IN
01
—
50401
LICENSE
KY
05
—
7100475900
—
KY
01
—
K240890
MEDICARE
KY
Enumeration date
05/20/2012
Last updated
11/15/2022
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