Individual
DR. MATTHEW ROBERT CODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 922-9270
(231) 922-9271
Mailing address
PO BOX 107, TRAVERSE CITY, MI 49685-0107
(231) 922-9270
(231) 922-9271
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301088741
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2081349
FACILITY FQHC MEDICAID #
OH
Enumeration date
03/29/2007
Last updated
11/10/2011
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