Provider Demographics
NPI:1043457757
Name:BIRDWHISTELL, MATTHEW C (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:BIRDWHISTELL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-6200
Mailing Address - Fax:859-258-6203
Practice Address - Street 1:1138 LEXINGTON RD
Practice Address - Street 2:SUITE 290
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9672
Practice Address - Country:US
Practice Address - Phone:502-863-0721
Practice Address - Fax:502-863-6104
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2023-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY03293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100160510Medicaid
KY03293OtherLICENSE
KY03293OtherLICENSE