Organization
ALEX MATAVERDE MD PC
Active
Other names
NONE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEX Q MATAVERDE M.D. (PHYSICIAN)
(313) 336-3180
Entity
Organization
Contact information
Practice address
15101 SOUTHFIELD RD, ALLEN PARK, MI 48101-2697
(313) 336-3180
(313) 593-4648
Mailing address
15101 SOUTHFIELD RD, ALLEN PARK, MI 48101-2697
(313) 336-3180
(313) 593-4648
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301031512
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1430258
—
MI
01
—
4301031512
LICENSE
MI
Enumeration date
03/10/2010
Last updated
05/19/2010
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