Healthcare Provider Details

I. General information

NPI: 1821037268
Provider Name (Legal Business Name): MATTHEW ALLEN TRIPP PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E COLBY ST
WHITEHALL MI
49461
US

IV. Provider business mailing address

PO BOX 1848
MUSKEGON MI
49443-1848
US

V. Phone/Fax

Practice location:
  • Phone: 231-728-5910
  • Fax: 231-728-5918
Mailing address:
  • Phone: 231-727-5211
  • Fax: 231-727-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601002724
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: