Healthcare Provider Details

I. General information

NPI: 1487739157
Provider Name (Legal Business Name): PATRICIA MATTEVI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRIACIA A MATTEVI MD

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BAY PARK DR
OREGON OH
43616-4920
US

IV. Provider business mailing address

7707 CHESTNUT RDG
MAUMEE OH
43537-8995
US

V. Phone/Fax

Practice location:
  • Phone: 419-690-7900
  • Fax: 419-866-5453
Mailing address:
  • Phone: 419-868-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35066848
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: