Healthcare Provider Details

I. General information

NPI: 1013610955
Provider Name (Legal Business Name): MATTHEW RAYESKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 4TH AVENUE E
GLADSTONE MI
49837
US

IV. Provider business mailing address

145 4TH AVENUE E
GLADSTONE MI
49837-1929
US

V. Phone/Fax

Practice location:
  • Phone: 906-428-3273
  • Fax: 906-428-1881
Mailing address:
  • Phone: 906-428-3273
  • Fax: 906-428-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101029352
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: