MEDICARE: DR. JAMES G MATRISCIANO M.D.

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	207R00000X	Internal Medicine Physician	10153R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00113832	OTHER	LA	RR MEDICARE 001
3	P00296719	OTHER	LA	RR MEDICARE 099

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952351769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES G MATRISCIANO M.D.

Provider Business Mailing Address
First Line	:	21333 HAGGERTY RD
Second Line	:	SUITE 150
City	:	NOVI
State	:	MI
Zip	:	48375-5510
Country	:	US
Telephone Number	:	248-662-0250
Fax Number	:

Provider Business Practice Location Address
First Line	:	15704 MEDICAL ARTS DR
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1446
Country	:	US
Telephone Number	:	985-542-0110
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JAMES G MATRISCIANO M.D.” Practice Location

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