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Individual

DR. MATTHEW G SMALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
965 S BAILEY AVE, SUITE 2-1, SOUTH HAVEN, MI 49090-9701
(269) 639-2772
(269) 639-2770
Mailing address
965 S BAILEY AVE, SUITE 2-1, SOUTH HAVEN, MI 49090-9701
(269) 639-2772
(269) 639-2770

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301083155
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4628853 T10
MI
Enumeration date
07/18/2006
Last updated
11/30/2016
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