Provider Demographics
NPI:1457328676
Name:GRUNKEMEYER, MATTHEW SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:GRUNKEMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-2663
Mailing Address - Fax:859-817-7848
Practice Address - Street 1:560 S LOOP RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3405
Practice Address - Country:US
Practice Address - Phone:859-301-2663
Practice Address - Fax:859-817-7848
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087407207X00000X
IN01071430A207X00000X
TXL8355207X00000X
KY39944207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00324935OtherRAILROAD MEDICARE
KY90008962OtherMEDICAID DME
KY428850004OtherMEDICARE DME
KY000000388274OtherANTHEM
KY64120900Medicaid
KY0000262307303OtherUNITED HEALTHCARE
KY1500392OtherCIGNA
KYCB8861OtherRAILROAD MEDICAREQ
KY1500392OtherCIGNA
KYP00324935OtherRAILROAD MEDICARE
KYCB8861OtherRAILROAD MEDICAREQ