| Jeetender Matharu Md Plc | |
|
7250 Dixie Hwy Ste 100 Clarkston MI 48346-5108 | |
| (248) 620-3500 | |
| (248) 620-3503 |
| Full Name | Jeetender Matharu Md Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 7250 Dixie Hwy, Clarkston, Michigan |
| Authorized Official Name and Position | Jeetender S Matharu (OWNER) |
| Authorized Official Contact | 2486203500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeetender Matharu Md Plc 7250 Dixie Hwy Ste 100 Clarkston MI 48346-5108 Ph: (248) 620-3500 | Jeetender Matharu Md Plc 7250 Dixie Hwy Ste 100 Clarkston MI 48346-5108 Ph: (248) 620-3500 |
| NPI Number | 1407047780 |
|---|---|
| Provider Enumeration Date | 08/05/2007 |
| Last Update Date | 01/26/2012 |
| Medicare PECOS PAC ID | 9931290962 |
|---|---|
| Medicare Enrollment ID | O20070806000676 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407047780 | NPI | - | NPPES |
| 4483424 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301070179 (Michigan) | Primary |
| Provider Name | Jeetender S Matharu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255310397 PECOS PAC ID: 7911993589 Enrollment ID: I20040421000670 |
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