| Doctor Name: | MATTHEW ENZWEILER |
| NPI Number: | 1023017522 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 00223 |
| Business Practice Address: | 525 Alexandria Pike Suite 230 Southgate, KY - 410713290 |
| Business Phone Number: | 8594414334 |
| Business Fax Number: | 8594413698 |
| Mailing Address: | 2300 Chamber Center Dr, Ste 200 LAKESIDE PARK |
| State: | KY |
| Postal Code: | 410171673 |
| Phone Number: | 8594414334 |
| Fax Number: | 8594413698 |
| NPI Enumeration Date: | 07/18/2005 |
| NPI Last Update Date: | 09/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 00223 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |