Provider Demographics
NPI:1083953129
Name:MATOVSKI, ANNE S (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:S
Last Name:MATOVSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:S
Other - Last Name:SIMOPOULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:43740 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1122
Mailing Address - Country:US
Mailing Address - Phone:586-228-0270
Mailing Address - Fax:586-228-9019
Practice Address - Street 1:28098 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2316
Practice Address - Country:US
Practice Address - Phone:586-949-0123
Practice Address - Fax:586-228-9019
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006603363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant