Provider Demographics
NPI:1598896367
Name:MATOSSIAN, VIKEN RAFFI (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKEN
Middle Name:RAFFI
Last Name:MATOSSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8548
Mailing Address - Country:US
Mailing Address - Phone:517-548-1537
Mailing Address - Fax:517-548-9399
Practice Address - Street 1:2901 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8548
Practice Address - Country:US
Practice Address - Phone:517-548-1537
Practice Address - Fax:517-548-9399
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010619792084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF37841Medicare UPIN
MI0478841Medicare ID - Type Unspecified