Provider Demographics
NPI:1376501502
Name:MAATMAN, THOMAS J (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:MAATMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4047 E. HILLS COURT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6249
Mailing Address - Country:US
Mailing Address - Phone:616-956-9577
Mailing Address - Fax:616-956-5988
Practice Address - Street 1:4047 E. HILLS COURT SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6249
Practice Address - Country:US
Practice Address - Phone:616-956-9577
Practice Address - Fax:616-956-5988
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007634208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5411590OtherPTAN
MI1973261Medicaid
N93770002Medicare PIN
MI1973261Medicaid