Provider Demographics
NPI:1497726780
Name:MICHAEL J MATTICE MD
Entity Type:Organization
Organization Name:MICHAEL J MATTICE MD
Other - Org Name:URGENT CARE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATTICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-564-0175
Mailing Address - Street 1:2050 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-564-0175
Mailing Address - Fax:772-770-1171
Practice Address - Street 1:2050 40TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-564-0175
Practice Address - Fax:772-770-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K0298Medicare ID - Type Unspecified