Provider Demographics
NPI:1376706762
Name:BUSH, MATTHEW LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LEE
Last Name:BUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 ROSE STREET,
Mailing Address - Street 2:UKMC DEPARTMENT OF OTOLARYNGOLOGY SUITE C-236
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-257-5097
Mailing Address - Fax:859-257-5096
Practice Address - Street 1:UKMC DEPARTMENT OF OTOLARYNGOLOGY
Practice Address - Street 2:800 ROSE STREET, SUITE C-236
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-257-5097
Practice Address - Fax:859-257-5096
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092641207Y00000X
KY43990207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY104070Medicare UPIN