Provider Demographics
NPI:1568460152
Name:MONDE-MATTHEWS, MARIE-JEANNE D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE-JEANNE
Middle Name:D
Last Name:MONDE-MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 33321
Mailing Address - Street 2:DRAWER 117
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-5321
Mailing Address - Country:US
Mailing Address - Phone:248-358-2410
Mailing Address - Fax:248-358-2470
Practice Address - Street 1:29255 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1018
Practice Address - Country:US
Practice Address - Phone:248-358-2410
Practice Address - Fax:248-358-2470
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4483470Medicare ID - Type Unspecified
MIF66041Medicare UPIN
MION68270002Medicare ID - Type Unspecified