Provider Demographics
NPI:1457628570
Name:F .MATUK M.D.,P.A.
Entity Type:Organization
Organization Name:F .MATUK M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAIRUZ
Authorized Official - Middle Name:F
Authorized Official - Last Name:MATUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-752-7001
Mailing Address - Street 1:32 SUNTREE PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7689
Mailing Address - Country:US
Mailing Address - Phone:321-752-7001
Mailing Address - Fax:321-242-1380
Practice Address - Street 1:32 SUNTREE PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7689
Practice Address - Country:US
Practice Address - Phone:321-752-7001
Practice Address - Fax:321-242-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME036280207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51281Medicare UPIN