Provider Demographics
NPI:1710002886
Name:PAGE, MATHEW ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:ALAN
Last Name:PAGE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2797 SPRING ARBOR ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203
Mailing Address - Country:US
Mailing Address - Phone:517-784-0900
Mailing Address - Fax:517-784-7835
Practice Address - Street 1:2797 SPRING ARBOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3605
Practice Address - Country:US
Practice Address - Phone:517-784-0900
Practice Address - Fax:517-784-7835
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIMP001981213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU81465Medicare UPIN