Provider Demographics
NPI:1073508297
Name:KEUM, MATTHEW MINSEOK (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MINSEOK
Last Name:KEUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36060 EUCLID AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4661
Mailing Address - Country:US
Mailing Address - Phone:440-269-4990
Mailing Address - Fax:440-269-4991
Practice Address - Street 1:36060 EUCLID AVE STE 101
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4661
Practice Address - Country:US
Practice Address - Phone:440-269-4990
Practice Address - Fax:440-269-4991
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350780372081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2253289Medicaid
OH2253289Medicaid
G29683Medicare UPIN