Organization
ADNAN MATTA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADNAN HALIM MATTA (PRESIDENT)
(586) 838-4441
Entity
Organization
Contact information
Practice address
4090 E 14 MILE RD STE 100, WARREN, MI 48092-1196
(586) 838-4441
(586) 838-4641
Mailing address
4090 E14 MILE RD STE 100, WARREN, MI 48092-1196
(586) 838-4441
(586) 838-4641
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
4301034389
MI
208D00000X
General Practice Physician
4301034389
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0206353551
BCBS
MI
05
—
101701996
—
MI
01
—
=========
COMMERCIAL
MI
Enumeration date
05/19/2008
Last updated
01/16/2025
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