Provider Demographics
NPI:1386868123
Name:RENDEL, MATTHEW AARON (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:RENDEL
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 1:1130 W 4TH ST STE 3204
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1345
Mailing Address - Country:US
Mailing Address - Phone:785-505-5815
Mailing Address - Fax:785-505-5278
Practice Address - Street 1:1130 W 4TH ST STE 3204
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:785-505-5815
Practice Address - Fax:785-505-5278
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9406108207T00000X
IN01071850A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01124526OtherRAILROAD MEDICARE
IN000000793361OtherANTHEM
IN201115940Medicaid
IN266180055Medicare PIN