Individual
MARK W MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
G4007 W COURT ST, SUITE E, FLINT, MI 48532-3560
(810) 732-0908
(810) 732-1630
Mailing address
G4007 W COURT ST, SUITE E, FLINT, MI 48532-3560
(810) 732-0908
(810) 732-1630
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
4301068512
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N53520
MEDICARE
MI
01
—
11500
MCARE
MI
01
—
4590228
MEDICAID
MI
01
—
7676408
AETNA
MI
01
—
BLUE CROSS BLUE SHIE
BLUE SHIELD BLUE SHIELD
MI
01
—
BLUE CROSS COMMUNITY
BLUE CROSS COMMUNITY BLUE
MI
Enumeration date
01/15/2007
Last updated
07/09/2007
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