Individual
DR. MATTHEW WESLEY MEDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7686 GEORGETOWN CENTER DR, JENISON, MI 49428-8101
(616) 252-8600
(616) 252-8660
Mailing address
5900 BYRON CENTER AVE SW, ATTN: MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101020024
MI
390200000X
Student in an Organized Health Care Education/Training Program
5101020024
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5101020024
OSTEOPATHIC MEDICINE AND SURGERY PHYSICIAN LICENSE
MI
01
—
5315055607
BOARD OF PHARMACY CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
06/25/2012
Last updated
03/07/2023
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