MEDICARE: GODWIN SALIFU MATTHEW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD20899	ME

General Provider Information

NPI Number	:	1831676964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GODWIN SALIFU MATTHEW MD

Provider Business Mailing Address
First Line	:	3328 HORNED LARK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3328 HORNED LARK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7712
Country	:	US
Telephone Number	:	205-249-8491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2018
Last Update Date	:	07/21/2018

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