Provider Demographics
NPI:1518224906
Name:MATTHEW M KEUM, M.D., INC
Entity Type:Organization
Organization Name:MATTHEW M KEUM, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-269-4990
Mailing Address - Street 1:36060 EUCLID AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4656
Mailing Address - Country:US
Mailing Address - Phone:440-269-4990
Mailing Address - Fax:440-269-4991
Practice Address - Street 1:36060 EUCLID AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4656
Practice Address - Country:US
Practice Address - Phone:440-269-4990
Practice Address - Fax:440-269-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078037208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty