Provider Demographics
NPI:1992187371
Name:TELLMAN, MATTHEW WILLIAM (MD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:TELLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-890-2000
Mailing Address - Fax:
Practice Address - Street 1:14300 E 138TH BLDG A
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-0087
Practice Address - Country:US
Practice Address - Phone:317-890-2000
Practice Address - Fax:317-813-1667
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083921A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology