Provider Demographics
NPI:1841242815
Name:MATTA, ADNAN H (MD)
Entity type:Individual
Prefix:DR
First Name:ADNAN
Middle Name:H
Last Name:MATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4090 E14 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1196
Mailing Address - Country:US
Mailing Address - Phone:586-858-4111
Mailing Address - Fax:586-858-4641
Practice Address - Street 1:4090 E 14 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1196
Practice Address - Country:US
Practice Address - Phone:586-858-4111
Practice Address - Fax:586-858-4641
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAM0343892086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101701996Medicaid
MI0206353551OtherBCBS
MI382296393OtherCOMMERCIAL
MIP57350001Medicare PIN
MI0206353551OtherBCBS
MI382296393OtherCOMMERCIAL