Provider Demographics
NPI:1700882594
Name:MATUS, CORAL D (MD)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:D
Last Name:MATUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-5555
Mailing Address - Fax:419-383-3113
Practice Address - Street 1:3333 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2426
Practice Address - Country:US
Practice Address - Phone:419-383-5555
Practice Address - Fax:419-383-3113
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000030643OtherANTHEM MEDICAID
MI142109OtherPRIORITY HEALTH
OH2071092Medicaid
OH7155935002OtherCIGNA
OH344428256OtherBEECH STREET
OH0104383OtherUNITED
OH142072OtherCARE CHOICES
MI344428256OtherPHCS
OH000000030643OtherANTHEM
OH5030651OtherAETNA
MI5030651OtherPPOM
OH26094OtherNATIONWIDE
MI6898OtherHPM
OHMA7250611Medicare PIN
MI6898OtherHPM
OH344428256OtherBEECH STREET
OH0104383OtherUNITED