| Organization Name: | ALEX MATAVERDE MD PC |
| NPI Number: | 1417270018 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALEX Q MATAVERDE (PHYSICIAN) |
| Mailing Address: | 15101 Southfield Rd Allen Park |
| State: | MI US |
| Postal Code: | 481012697 |
| Phone Number: | 3133363180 |
| Fax Number: | 3135934648 |
| NPI Enumeration Date: | 03/10/2010 |
| NPI Last Update Date: | 05/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4301031512 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |