Provider Demographics
NPI:1821087263
Name:CATERINE, MATTHEW
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:CATERINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14309 WOODSON ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19609 E 9TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056-3088
Practice Address - Country:US
Practice Address - Phone:816-796-1412
Practice Address - Fax:816-796-3398
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020000932085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205834203Medicaid
MO300129106OtherRR MEDICARE
KS100414880BMedicaid
MOP00102244OtherRR MEDICARE
KSP00313595OtherRR MEDICARE
MOP00102244OtherRR MEDICARE
MOG99007Medicare UPIN
MO300129106Medicare PIN
KSK67B457AMedicare PIN
KSP00313595Medicare PIN
MO300129106OtherRR MEDICARE