Provider Demographics
NPI:1295975233
Name:O L MATTHEWS MD PC
Entity type:Organization
Organization Name:O L MATTHEWS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:O L
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-949-9888
Mailing Address - Street 1:29201 TELEGRAPH RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7647
Mailing Address - Country:US
Mailing Address - Phone:248-949-9888
Mailing Address - Fax:248-325-5998
Practice Address - Street 1:29201 TELEGRAPH RD STE 400
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7647
Practice Address - Country:US
Practice Address - Phone:248-949-9888
Practice Address - Fax:248-325-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0608226582OtherBLUE CROSS BLUE SHIELD OF MI PIN
MI1805767Medicaid
MI0822658Medicare PIN