Organization
MICHAEL J MATTINGLY, D.O. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JOHN MATTINGLY DO (OWNER)
(248) 676-8533
Entity
Organization
Contact information
Practice address
1000 HARRINGTON ST, MOUNT CLEMENS, MI 48043-2920
(586) 493-8101
Mailing address
8573 RELIABLE PKWY, CHICAGO, IL 60686-0001
(866) 898-7139
(616) 975-9824
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0155012295
BCBS
—
01
—
0E02243
BCN ADVANTAGE
—
Enumeration date
11/21/2006
Last updated
07/28/2008
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