Provider Demographics
NPI:1750674222
Name:KANGAS, MATTHEW DONALD (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DONALD
Last Name:KANGAS
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:PO BOX 931320 ATLANTA GA 31193-1320
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1320
Mailing Address - Country:US
Mailing Address - Phone:901-519-3414
Mailing Address - Fax:
Practice Address - Street 1:55 HUMPHREYS CENTER DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2374
Practice Address - Country:US
Practice Address - Phone:901-519-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54762207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I0544498Medicare PIN