Provider Demographics
NPI:1932549128
Name:KERELIUK, MATTHEW RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RICHARD
Last Name:KERELIUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MARYCROFT AVE.
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4L 5X8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 MARYCROFT AVE.
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:ONTARIO
Practice Address - Zip Code:L4L 5X8
Practice Address - Country:CA
Practice Address - Phone:905-856-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine