Provider Demographics
NPI:1609811975
Name:AL-MATCHY, VICTOR P (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:P
Last Name:AL-MATCHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7386 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5865
Mailing Address - Country:US
Mailing Address - Phone:248-635-5900
Mailing Address - Fax:586-275-0066
Practice Address - Street 1:37300 DEQUINDRE RD
Practice Address - Street 2:STE 120
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3591
Practice Address - Country:US
Practice Address - Phone:586-275-0065
Practice Address - Fax:586-275-0066
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4889519-10Medicaid
MI700E027480OtherBCBS
MI4889519-10Medicaid