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General NPI Number Information
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NPI Number | 1659359164
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Entity Type | Individual
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Provider Name | TERRY MERRILL MATTHEWS D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 02/26/2022
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Provider Practice Location Address
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Address Line | 505 N CLIPPERT ST
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City | LANSING
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State | MI
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Zip | 48912-4701
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Country | US
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Telephone | 517-285-0905
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Fax |
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Provider Business Mailing Address
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Address Line | 16945 MARSH RD STE A
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City | HASLETT
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State | MI
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Zip | 48840-8948
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Country | US
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Telephone | 517-333-9200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101014149
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 5101014149
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License Number State | MI
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