Provider Demographics
NPI:1811992266
Name:MATUK, F (MDPA)
Entity type:Individual
Prefix:DR
First Name:F
Middle Name:
Last Name:MATUK
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SUNTREE PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7689
Mailing Address - Country:US
Mailing Address - Phone:321-752-7001
Mailing Address - Fax:321-242-1380
Practice Address - Street 1:32 SUNTREE PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7689
Practice Address - Country:US
Practice Address - Phone:321-752-7001
Practice Address - Fax:321-242-1380
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME036280174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039565000Medicaid
FL05414Medicare ID - Type Unspecified
FL039565000Medicaid