Healthcare Provider Details

I. General information

NPI: 1841242815
Provider Name (Legal Business Name): ADNAN H MATTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37300 DEQUINDRE RD STE 201
STERLING HEIGHTS MI
48310-3597
US

IV. Provider business mailing address

37300 DEQUINDRE RD STE 201
STERLING HEIGHTS MI
48310-3597
US

V. Phone/Fax

Practice location:
  • Phone: 586-858-4111
  • Fax: 586-858-4641
Mailing address:
  • Phone: 586-858-4111
  • Fax: 586-858-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberAM034389
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: