Provider Demographics
NPI:1346355179
Name:EVENHOUSE, MATTHEW H (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:H
Last Name:EVENHOUSE
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 1:304 RUTH ST
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-1228
Mailing Address - Country:US
Mailing Address - Phone:614-902-0771
Mailing Address - Fax:
Practice Address - Street 1:1991 CROCKER RD STE 500
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1962
Practice Address - Country:US
Practice Address - Phone:844-764-4633
Practice Address - Fax:310-861-0855
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082452208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2420893Medicaid
OHH90977Medicare UPIN
OH2420893Medicaid