Provider Demographics
NPI:1982876405
Name:DR STEVEN M MATLEN PC
Entity Type:Organization
Organization Name:DR STEVEN M MATLEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-435-3668
Mailing Address - Street 1:139 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1965
Mailing Address - Country:US
Mailing Address - Phone:248-435-3668
Mailing Address - Fax:248-435-3673
Practice Address - Street 1:139 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1965
Practice Address - Country:US
Practice Address - Phone:248-435-3668
Practice Address - Fax:248-435-3673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR STEVEN M MATLEN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000994213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI211393413Medicaid
MI5635036Medicare PIN