Basic Information
| Provider Information | |||||||||
| NPI: | 1376706762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 ROSE STREET, | ||||||||
| Address2: | UKMC DEPARTMENT OF OTOLARYNGOLOGY SUITE C-236 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592575097 | ||||||||
| FaxNumber: | 8592575096 | ||||||||
| Practice Location | |||||||||
| Address1: | UKMC DEPARTMENT OF OTOLARYNGOLOGY | ||||||||
| Address2: | 800 ROSE STREET, SUITE C-236 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592575097 | ||||||||
| FaxNumber: | 8592575096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 03/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 35.092641 | OH | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0901X | 43990 | KY | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology |
No ID Information.