Individual
MATTHEW JOSEPH BAUTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
6549 TOWN CENTER DR STE A, CLARKSTON, MI 48346-4824
(800) 395-3223
(833) 329-6632
Mailing address
6549 TOWN CENTER DR STE A, CLARKSTON, MI 48346-4824
(800) 395-3223
(833) 329-6632
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704341284
MI
363LF0000X
Family Nurse Practitioner
2023000523
MI
363LF0000X
Family Nurse Practitioner
Primary
4704341284
MI
Other
Enumeration date
09/12/2022
Last updated
04/29/2023
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