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General NPI Number Information
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NPI Number | 1801371315
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Entity Type | Organization
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Legal Business Name | MATRIX MEDICAL PLLC
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 52611 BLUERIDGE DR
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City | SHELBY TWP
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State | MI
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Zip | 48316-2977
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Country | US
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Telephone | 586-530-0133
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Fax | 586-262-4158
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Provider Business Mailing Address
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Address Line | 52611 BLUERIDGE DR
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City | SHELBY TWP
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State | MI
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Zip | 48316-2977
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Country | US
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Telephone | 586-530-0133
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Fax | 586-262-4158
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ALEXANDER CUSMANO
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Credential | MD
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Telephone | 586-530-0133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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