Individual
MILES J MATTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1414 W FAIR AVE, SUITE 249, MARQUETTE, MI 49855-2675
(906) 225-7780
(906) 225-4893
Mailing address
4602 DEPT, CAROL STREAM, IL 60122-0021
(906) 225-4821
(906) 225-4537
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4301041253
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2794971
—
MI
01
—
MM041253
BCBSM
MI
Enumeration date
01/05/2006
Last updated
04/21/2009
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