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General NPI Number Information
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NPI Number | 1841242815
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Entity Type | Individual
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Provider Name | ADNAN H MATTA MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 4090 E 14 MILE RD STE 100
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City | WARREN
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State | MI
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Zip | 48092-1196
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Country | US
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Telephone | 586-858-4111
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Fax | 586-858-4641
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Provider Business Mailing Address
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Address Line | 4090 E14 MILE RD STE 100
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City | WARREN
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State | MI
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Zip | 48092-1196
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Country | US
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Telephone | 586-858-4111
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Fax | 586-858-4641
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | AM034389
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License Number State | MI
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