Provider Demographics
NPI:1225052798
Name:BAIN, MATTHEW E (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:BAIN
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 1:102 S MAIN ST STE 245
Mailing Address - Street 2:
Mailing Address - City:KIRKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46050-9060
Mailing Address - Country:US
Mailing Address - Phone:765-335-6301
Mailing Address - Fax:317-854-9256
Practice Address - Street 1:102 S MAIN ST STE 245
Practice Address - Street 2:
Practice Address - City:KIRKLIN
Practice Address - State:IN
Practice Address - Zip Code:46050-9060
Practice Address - Country:US
Practice Address - Phone:765-335-6301
Practice Address - Fax:317-854-9256
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059069A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000357188OtherANTHEM
IN200507530Medicaid
IN200507530Medicaid
IN262210KMedicare PIN
IN262210KMedicare PIN