Individual
DR. JAMES G MATRISCIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15704 MEDICAL ARTS DR, HAMMOND, LA 70403-1446
(985) 542-0110
Mailing address
21333 HAGGERTY RD, SUITE 150, NOVI, MI 48375-5510
(248) 662-0250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10153R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1976725
—
LA
01
—
P00113832
RR MEDICARE 001
LA
01
—
P00296719
RR MEDICARE 099
LA
Enumeration date
05/11/2006
Last updated
07/08/2007
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