Provider Demographics
NPI:1003930215
Name:COTANT, MATTHEW BURNS (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BURNS
Last Name:COTANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3577 W 13 MILE RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:248-551-6900
Mailing Address - Fax:248-551-6909
Practice Address - Street 1:3577 W 13 MILE RD
Practice Address - Street 2:SUITE 404
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-6900
Practice Address - Fax:248-551-6909
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301077875207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301077875OtherPHYSICIAN LICENSE