Provider Demographics
NPI:1801371315
Name:MATRIX MEDICAL PLLC
Entity Type:Organization
Organization Name:MATRIX MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSMANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-530-0133
Mailing Address - Street 1:52611 BLUERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-2977
Mailing Address - Country:US
Mailing Address - Phone:586-530-0133
Mailing Address - Fax:586-262-4158
Practice Address - Street 1:52611 BLUERIDGE DR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-2977
Practice Address - Country:US
Practice Address - Phone:586-530-0133
Practice Address - Fax:586-262-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty