Provider Demographics
NPI:1407823081
Name:KULKE, MATTHEW HELMUT (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:HELMUT
Last Name:KULKE
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 1:265 WESTERN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2458
Mailing Address - Country:US
Mailing Address - Phone:207-661-0200
Mailing Address - Fax:207-661-0299
Practice Address - Street 1:265 WESTERN AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2458
Practice Address - Country:US
Practice Address - Phone:207-661-0200
Practice Address - Fax:207-661-0299
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2025-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD29756207R00000X, 207RX0202X
MA80794207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110057382AMedicaid
2074420OtherAETNA US HEALTHCARE
3000433OtherUNITED HEALTH CARE
MA3154769Medicaid
51187OtherFALLON COMMUNITY HEALTH
0043742OtherCIGNA
G07365DFOtherHPHC DFCI ONLY
MA3154769Medicaid
764636OtherTUFTS