Provider Demographics
NPI:1831294487
Name:WOODS, MATTHEW BERNARD IV (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BERNARD
Last Name:WOODS
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N MAIN ST
Mailing Address - Street 2:PO BOX 454
Mailing Address - City:OLIVET
Mailing Address - State:MI
Mailing Address - Zip Code:49076-9465
Mailing Address - Country:US
Mailing Address - Phone:269-749-2131
Mailing Address - Fax:269-749-3067
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OLIVET
Practice Address - State:MI
Practice Address - Zip Code:49076-9465
Practice Address - Country:US
Practice Address - Phone:269-749-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104763894Medicaid
I38247Medicare UPIN
MI0A37669Medicare PIN
MI104763894Medicaid