Individual
AMANDA MATUSIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
34208 VAN DYKE AVE, STERLING HEIGHTS, MI 48312-4647
(586) 554-7136
(586) 883-9694
Mailing address
34208 VAN DYKE AVE, STERLING HEIGHTS, MI 48312-4647
(586) 554-7136
(586) 883-9694
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007420
MI
363A00000X
Physician Assistant
TC021
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601007420
PHYSICIAN ASSISTANT STATE LICENSE
MI
Enumeration date
08/02/2011
Last updated
07/01/2016
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