Provider Demographics
NPI:1629654413
Name:ISHERWOOD, MATTHEW DAVID I (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:ISHERWOOD
Suffix:I
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1148 CONNIE AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2960
Mailing Address - Country:US
Mailing Address - Phone:586-872-1221
Mailing Address - Fax:
Practice Address - Street 1:7125 ORCHARD LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3616
Practice Address - Country:US
Practice Address - Phone:248-865-7444
Practice Address - Fax:734-667-2579
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601010434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant