Provider Demographics
NPI:1740240100
Name:MATTSON, JOAN C (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:MATTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15344 CLUB COURSE DR
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:MI
Mailing Address - Zip Code:48808-8797
Mailing Address - Country:US
Mailing Address - Phone:517-641-4264
Mailing Address - Fax:517-641-4683
Practice Address - Street 1:15344 CLUB COURSE DR
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:MI
Practice Address - Zip Code:48808-8797
Practice Address - Country:US
Practice Address - Phone:517-641-4264
Practice Address - Fax:517-641-4683
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301029816207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology