Provider Demographics
NPI:1063505568
Name:GREENSPAN, MATTHEW HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HOWARD
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 S OCEAN DR APT 1810
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7680
Mailing Address - Country:US
Mailing Address - Phone:888-886-5238
Mailing Address - Fax:888-886-9330
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010542422085R0202X
NJ25MA098132002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4166015Medicaid
MI4166015OtherMOLINA HEALTHCARE
MI300107168OtherRAILROAD MEDICARE
MI802538OtherCOMMUNITY CARE PLAN
MI29743OtherCOMMUNITY CHOICE OF MI
MI4166015OtherHEALTH PLAN OF MI
MI300107168OtherRAILROAD MEDICARE
MI4166015OtherMOLINA HEALTHCARE
MI0M55900007Medicare ID - Type Unspecified
MI0N55390032Medicare UPIN