Provider Demographics
NPI:1013778026
Name:SHRONTZ, MATTHEW MICHAEL
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:SHRONTZ
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 1:1305 FORK LICK RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:KY
Mailing Address - Zip Code:41010-8515
Mailing Address - Country:US
Mailing Address - Phone:330-692-8678
Mailing Address - Fax:
Practice Address - Street 1:1305 FORK LICK RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:KY
Practice Address - Zip Code:41010-8515
Practice Address - Country:US
Practice Address - Phone:330-692-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty