Provider Demographics
NPI:1932969755
Name:JOSEPH, MATTHEW ALEXANDER
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41864 MARY KAY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4500
Mailing Address - Country:US
Mailing Address - Phone:586-713-7488
Mailing Address - Fax:
Practice Address - Street 1:41864 MARY KAY DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4500
Practice Address - Country:US
Practice Address - Phone:586-713-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker