Individual
DR. MATTHEW L VISCONTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1114 CHARLEVOIX AVE, PETOSKEY, MI 49770-9701
(231) 439-9700
(231) 439-9709
Mailing address
1114 CHARLEVOIX AVE, PETOSKEY, MI 49770-9701
(231) 439-9700
(231) 439-9709
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301407390
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4356252
—
MI
05
—
4732181
—
MI
05
—
4777030
—
MI
05
—
4926793
—
MI
Enumeration date
05/31/2006
Last updated
02/12/2010
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