Provider Demographics
NPI:1821780180
Name:KELM, MATTHEW EWING
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EWING
Last Name:KELM
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 1:1942 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3416
Mailing Address - Country:US
Mailing Address - Phone:458-895-4974
Mailing Address - Fax:
Practice Address - Street 1:1942 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3416
Practice Address - Country:US
Practice Address - Phone:458-895-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000108871175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist