Provider Demographics
NPI:1942543483
Name:PREKUPEC, MATTHEW PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PETER
Last Name:PREKUPEC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22825 E 9 MILE RD
Mailing Address - Street 2:APT 1
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1934
Mailing Address - Country:US
Mailing Address - Phone:519-726-5470
Mailing Address - Fax:
Practice Address - Street 1:10624 S EASTERN AVE # A-955
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2982
Practice Address - Country:US
Practice Address - Phone:702-800-5393
Practice Address - Fax:702-407-7016
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV18481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine