Provider Demographics
NPI:1942258306
Name:CITRON, MATTHEW EMANUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EMANUEL
Last Name:CITRON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-356-0098
Mailing Address - Fax:
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-356-0098
Practice Address - Fax:248-356-0424
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014308207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4871748Medicaid
MIH86865Medicare UPIN