Basic Information
| Provider Information | |||||||||
| NPI: | 1629287479 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAREY | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4525 W 6TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660497700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855055160 | ||||||||
| FaxNumber: | 7855055282 | ||||||||
| Practice Location | |||||||||
| Address1: | 4525 W 6TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660497700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855055160 | ||||||||
| FaxNumber: | 7855055282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 04-33097 | KS | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 110661023 | 01 | KS | MEDICARE PTAN | OTHER | 200566730C | 05 | KS | MEDICAID |