Individual
DR. DAVID N MATISOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3960 PATIENT CARE DR, SUITE 113, LANSING, MI 48911-4275
(517) 484-0004
(517) 484-7241
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
4301040001
MI
2080P0202X
Pediatric Cardiology Physician
DM040001
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350C31064
BLUE CROSS BLUE SHIELD
MI
01
—
40155
BLUE CARE NETWORK
MI
01
—
7500132
PHP
MI
05
—
L3338302
—
MI
Enumeration date
08/25/2005
Last updated
02/29/2016
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