Provider Demographics
NPI:1275063406
Name:MATUS, BETHANY A (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:A
Last Name:MATUS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 N BLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3518
Mailing Address - Country:US
Mailing Address - Phone:313-570-8473
Mailing Address - Fax:
Practice Address - Street 1:17400 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5439
Practice Address - Country:US
Practice Address - Phone:248-712-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered