# ADNAN MATTA MD PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922265982
- **Authorized official:** ADNAN HALIM MATTA (PRESIDENT)
- **Authorized official phone:** (586) 838-4441

## Contact information

- **Practice address:** 4090 E 14 MILE RD STE 100, WARREN, MI 48092-1196
- **Practice address phone:** (586) 838-4441
- **Practice address fax:** (586) 838-4641
- **Mailing address:** 4090 E14 MILE RD STE 100, WARREN, MI 48092-1196
- **Mailing address phone:** (586) 838-4441
- **Mailing address fax:** (586) 838-4641

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 4301034389 | MI | Yes |
| 208D00000X | General Practice Physician | 4301034389 | MI | — |

## Other

- **Enumeration date:** 05/19/2008
- **Last updated:** 01/16/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0206353551 | BCBS | MI |
| 05 | — | 101701996 | — | MI |
| 01 | — | ========= | COMMERCIAL | MI |