Individual
ETHAN ANTONY MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 966-3250
Mailing address
6853 BROOK HOLLOW CT, WEST BLOOMFIELD, MI 48322-5208
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/03/2026
Last updated
04/03/2026
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