Provider Demographics
NPI:1346239498
Name:NEUHAUS, MATTHEW D (DPM)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:NEUHAUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 STONECREST BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5688
Mailing Address - Country:US
Mailing Address - Phone:615-220-8788
Mailing Address - Fax:615-768-7881
Practice Address - Street 1:300 STONECREST BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5688
Practice Address - Country:US
Practice Address - Phone:615-220-8788
Practice Address - Fax:615-768-7881
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDPM609213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353883Medicaid
TNP00320782OtherMEDICARE RRB
TN5556260001Medicare NSC
TN3353884Medicare PIN
TN3353883Medicaid