Provider Demographics
NPI:1598787186
Name:SUTTON, MATTHEW B (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:SUTTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10787 NALL AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1301
Mailing Address - Country:US
Mailing Address - Phone:913-945-6900
Mailing Address - Fax:913-945-6970
Practice Address - Street 1:10787 NALL AVE STE 310
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1301
Practice Address - Country:US
Practice Address - Phone:913-945-6900
Practice Address - Fax:913-945-6970
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100855207R00000X
KS04-25466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208006817Medicaid
G07015Medicare UPIN