Provider Demographics
NPI:1982625356
Name:MATTES, FREDERIC HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:HOWARD
Last Name:MATTES
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 1:3036 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4128
Mailing Address - Country:US
Mailing Address - Phone:419-473-0431
Mailing Address - Fax:419-471-2460
Practice Address - Street 1:3900 SUNFOREST CT STE 136
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4440
Practice Address - Country:US
Practice Address - Phone:419-474-1104
Practice Address - Fax:419-473-2867
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045049M2085R0202X
OH35-045049M2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0439298Medicaid
MA0535112Medicare ID - Type Unspecified
OH0439298Medicaid