Provider Demographics
NPI:1902273931
Name:AITCHISON, MATTHEW LEE (MPA, PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LEE
Last Name:AITCHISON
Suffix:
Gender:M
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:818 N DELLROSE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3438
Mailing Address - Country:US
Mailing Address - Phone:360-621-2936
Mailing Address - Fax:
Practice Address - Street 1:700 W CENTRAL AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2184
Practice Address - Country:US
Practice Address - Phone:316-321-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical