Provider Demographics
NPI:1275638231
Name:MATTI, MAHIR (MD)
Entity Type:Individual
Prefix:
First Name:MAHIR
Middle Name:
Last Name:MATTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAHIR
Other - Middle Name:HANNA
Other - Last Name:MATTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:45453 RIVERWOODS DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:769 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4364
Practice Address - Country:US
Practice Address - Phone:734-331-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine