Provider Demographics
NPI:1225016660
Name:MATASOVIC, TEREZIA (MD)
Entity Type:Individual
Prefix:DR
First Name:TEREZIA
Middle Name:
Last Name:MATASOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 RIDGETOP RD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-4553
Mailing Address - Country:US
Mailing Address - Phone:515-292-2901
Mailing Address - Fax:
Practice Address - Street 1:3102 RIDGETOP RD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-4553
Practice Address - Country:US
Practice Address - Phone:515-292-2901
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31419207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E70078Medicare UPIN