| None | |
|
15101 Southfield Rd Allen Park MI 48101-2697 | |
| (313) 336-3180 | |
| (313) 593-4648 |
| Full Name | None |
|---|---|
| Speciality | General Practice |
| Location | 15101 Southfield Rd, Allen Park, Michigan |
| Authorized Official Name and Position | Alex Q Mataverde (PHYSICIAN) |
| Authorized Official Contact | 3133363180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 15101 Southfield Rd Allen Park MI 48101-2697 Ph: (313) 336-3180 | None 15101 Southfield Rd Allen Park MI 48101-2697 Ph: (313) 336-3180 |
| NPI Number | 1417270018 |
|---|---|
| Provider Enumeration Date | 03/10/2010 |
| Last Update Date | 05/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417270018 | NPI | - | NPPES |
| 1430258 | Medicaid | MI | |
| 4301031512 | Other | MI | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 4301031512 (Michigan) | Primary |
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