Basic Information
| Provider Information | |||||||||
| NPI: | 1174592554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEIN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 330 ARKANSAS ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858402800 | ||||||||
| FaxNumber: | 7858402813 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 ARKANSAS ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858402800 | ||||||||
| FaxNumber: | 7858402813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 05/20/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 04-20087 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 100137990B | 05 | KS | MEDICAID | 2546681 | 01 | AETNA INSURANCE | OTHER | 830007297 | 01 | MEDICARE RAILROAD | OTHER | 1373980 | 01 | FIRST HEALTH | OTHER | 48-6033703-018 | 01 | PRUDENTIAL | OTHER | 20299031 | 01 | BC/BS OF KANSAS CITY | OTHER | 620821 | 01 | FIRST GUARD | OTHER | 100531 | 01 | BC/BS OF KANSAS | OTHER | 04-01152 | 01 | UNITED HEALTHCARE | OTHER |