Provider Demographics
NPI:1780672402
Name:BESSEN, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BESSEN
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 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-566-6338
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-585-4321
Practice Address - Fax:502-566-6338
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042487A207RC0000X
KY30377207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY060066994OtherRAILROAD MEDICARE
KY64303779Medicaid
IN60054432OtherRAILROAD MEDICARE
IN200040800Medicaid
KY060053445OtherRAILROAD MEDICARE
KY0690803Medicare PIN
IN150690FMedicare PIN
KY00312010Medicare PIN
KY00314010Medicare PIN
IN251440MMedicare PIN
KY060053445OtherRAILROAD MEDICARE
KY64303779Medicaid
IN60054432OtherRAILROAD MEDICARE
KYP00612984Medicare PIN
KY00308010Medicare PIN
KY060066994OtherRAILROAD MEDICARE
KY0289313Medicare PIN
KY0640911Medicare PIN
KY1273218Medicare PIN
IN200040800Medicaid
IN126930OMedicare PIN
IN228550FMedicare PIN
KY00313010Medicare PIN