Provider Demographics
NPI:1548287501
Name:SUTTER, MATTHEW ROBERT (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:SUTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 2121
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4140
Mailing Address - Country:US
Mailing Address - Phone:260-435-7937
Mailing Address - Fax:260-435-7933
Practice Address - Street 1:7950 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 2121
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-435-7937
Practice Address - Fax:260-435-7933
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049247A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000088926OtherANTHEM
IN930093191OtherRAILROAD
IN00278190Medicaid
H15163Medicare UPIN
IN00278190Medicaid