Healthcare Provider Details

I. General information

NPI: 1467527192
Provider Name (Legal Business Name): MICHAEL J MATTINGLY, D.O. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HARRINGTON ST
MOUNT CLEMENS MI
48043-2920
US

IV. Provider business mailing address

8573 RELIABLE PKWY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 586-493-8101
  • Fax:
Mailing address:
  • Phone: 866-898-7139
  • Fax: 616-975-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOHN MATTINGLY
Title or Position: OWNER
Credential: DO
Phone: 248-676-8533