Provider Demographics
NPI:1992116073
Name:PYLE, MATTHEW R (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:PYLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S SANTA FE AVE SUITE 240
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-452-7366
Mailing Address - Fax:785-452-7354
Practice Address - Street 1:520 S SANTA FE AVE SUITE 240
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-452-7366
Practice Address - Fax:785-452-7354
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-08994207Q00000X
KS05-37994207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS05-37994OtherKS LICENSE
KS2011381308Medicaid