Provider Demographics
NPI:1811931389
Name:PIERZALA, MATTHEW JOHN (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:PIERZALA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1065
Mailing Address - Country:US
Mailing Address - Phone:606-638-0938
Mailing Address - Fax:859-813-5394
Practice Address - Street 1:125 S MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1065
Practice Address - Country:US
Practice Address - Phone:606-638-0938
Practice Address - Fax:859-813-5394
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3522207R00000X
KYKY02941207R00000X, 204C00000X
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1228266OtherCHA
KYP00340075OtherRAILROAD MEDICARE
KY2705602OtherOHIO DEPT OF JOB/FAMILY
KY7961767OtherAETNA
KY000000484549OtherANTHEM
KY7100027040Medicaid
KYI27769Medicare UPIN
KY7100027040Medicaid