Doctor Name: | DR. OL MATTHEWS |
NPI Number: | 1225096050 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 207R00000X |
Business Practice Address: | 3011 W Grand Blvd Suite 466 Detroit, MI - 482023096 |
Business Phone Number: | 3138713200 |
Business Fax Number: | 3138712996 |
Mailing Address: | Po Box 250719, FRANKLIN |
State: | MI |
Postal Code: | 480250719 |
Phone Number: | 3138713200 |
Fax Number: | 3138712996 |
NPI Enumeration Date: | 05/02/2006 |
NPI Last Update Date: | 11/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 207R00000X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |