Provider Demographics
NPI:1750379160
Name:MATHEW, K V (MD)
Entity type:Individual
Prefix:
First Name:K
Middle Name:V
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4448 OAKBRIDGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5494
Mailing Address - Country:US
Mailing Address - Phone:810-230-7905
Mailing Address - Fax:810-230-7908
Practice Address - Street 1:4448 OAKBRIDGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5494
Practice Address - Country:US
Practice Address - Phone:810-230-7905
Practice Address - Fax:810-230-7908
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIKM0333552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2602500091OtherBLUE CROSS NUMBER
MI2606491OtherHEALTHPLUS NUMBER
MI1081980Medicaid
MI2602500091OtherBLUE CROSS NUMBER
MI1081980Medicaid