Individual
MR. MICHAEL LEROY MATTESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
305 W JACKSON ST, SUITE 105, CARBONDALE, IL 62901-1474
(618) 536-2565
(618) 536-2835
Mailing address
PO BOX 1105, INDIANAPOLIS, IN 46206-1105
(618) 457-5200
(618) 351-4821
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
0110003884
VA
363AS0400X
Surgical Physician Assistant
Primary
385000710
IL
Other
Enumeration date
05/08/2008
Last updated
12/08/2025
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