Individual
MATTHEW WILLMAN HETTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4466 W BRISTOL RD, FLINT, MI 48507-3170
(810) 733-1200
(810) 733-0688
Mailing address
4466 W BRISTOL RD, FLINT, MI 48507-3170
(810) 733-1200
(810) 733-0688
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301065543
MI
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
4301065543
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B51156
GROUP BCBS
MI
01
—
0N45090
GROUP MEDICARE
—
01
—
1215930490
TYPE 2 NPI
—
05
—
4303713
—
MI
01
—
CB0923
GROUP RAILROAD
—
Enumeration date
11/14/2005
Last updated
09/19/2013
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