Provider Demographics
NPI:1265434328
Name:MCLEAY, MATTHEW THOMAS (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:MCLEAY
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 1:20375 W 151ST ST STE 451
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7210
Mailing Address - Country:US
Mailing Address - Phone:913-829-0446
Mailing Address - Fax:913-829-7829
Practice Address - Street 1:20375 W 151ST ST STE 451
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7210
Practice Address - Country:US
Practice Address - Phone:913-829-0446
Practice Address - Fax:913-829-7829
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-22824207RP1001X
NE19414207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1938647Medicaid
SD7712380Medicaid
NE271951Medicare ID - Type Unspecified
IAI12520Medicare ID - Type Unspecified
IA1938647Medicaid