Provider Demographics
NPI:1982271599
Name:MATTHEW LOUIS MD INC
Entity Type:Organization
Organization Name:MATTHEW LOUIS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-861-4966
Mailing Address - Street 1:255 E AVENIDA GRANADA UNIT 922
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-0438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39000 BOB HOPE DR.
Practice Address - Street 2:BANNAN BLDG - STE # 1109
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-834-3790
Practice Address - Fax:760-834-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty