Individual
MARINA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1500 EAST MEDICAL CENTER DR, 1ST FLOOR TAUBMAN CTR RECP C, ANN ARBOR, MI 48109-0322
(734) 936-9010
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
4301042055
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1486807
—
MI
Enumeration date
10/17/2006
Last updated
07/08/2007
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