# ALEX MATAVERDE MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NONE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417270018
- **Authorized official:** DR. ALEX Q MATAVERDE M.D. (PHYSICIAN)
- **Authorized official phone:** (313) 336-3180

## Contact information

- **Practice address:** 15101 SOUTHFIELD RD, ALLEN PARK, MI 48101-2697
- **Practice address phone:** (313) 336-3180
- **Practice address fax:** (313) 593-4648
- **Mailing address:** 15101 SOUTHFIELD RD, ALLEN PARK, MI 48101-2697
- **Mailing address phone:** (313) 336-3180
- **Mailing address fax:** (313) 593-4648

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301031512 | MI | Yes |

## Other

- **Enumeration date:** 03/10/2010
- **Last updated:** 05/19/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1430258 | — | MI |
| 01 | — | 4301031512 | LICENSE | MI |