Individual
DR. PHILIP ALEXANDER MATAVERDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3200 W CENTRE AVE STE 203, PORTAGE, MI 49024-4889
(269) 349-9745
Mailing address
3200 W CENTRE AVE STE 203, PORTAGE, MI 49024-4889
Taxonomy
Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
5101017269
MI
2084N0400X
Neurology Physician
2012020702
MO
2084N0400X
Neurology Physician
L1865858
MI
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
2012020702
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992996458
—
MO
01
—
P01092598
RAILROAD MEDICARE PTAN
MO
Enumeration date
08/08/2007
Last updated
11/27/2023
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