Provider Demographics
NPI:1629332382
Name:PRIOR, MATTHEW JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:PRIOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32901 23 MILE RD
Mailing Address - Street 2:SUIT 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4063
Mailing Address - Country:US
Mailing Address - Phone:586-725-8500
Mailing Address - Fax:586-725-5311
Practice Address - Street 1:32901 23 MILE RD
Practice Address - Street 2:SUIT 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4063
Practice Address - Country:US
Practice Address - Phone:586-725-8500
Practice Address - Fax:586-725-5311
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine