Provider Demographics
NPI:1427228899
Name:MATUGA, THEODORE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOHN
Last Name:MATUGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5534 BOBWHITE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-4593
Mailing Address - Country:US
Mailing Address - Phone:269-375-0336
Mailing Address - Fax:269-375-9266
Practice Address - Street 1:5534 BOBWHITE AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-4593
Practice Address - Country:US
Practice Address - Phone:269-375-0336
Practice Address - Fax:269-375-9266
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-02
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010458612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology