Individual
LALAINE E MATTISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5757 MONCLOVA RD, STE 25, MAUMEE, OH 43537-1863
(419) 482-9761
(419) 794-8296
Mailing address
7550 LUCERNE DR, STE 405, MIDDLEBURG HTS, OH 44130-6503
(440) 234-8833
(440) 234-3313
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
35062263
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000345516
ANTHEM
OH
01
—
02202
PARAMOUNT
OH
05
—
0258868
—
OH
01
—
P00146677
RAILROAD MEDICARE
OH
Enumeration date
07/13/2005
Last updated
11/03/2023
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