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General NPI Number Information
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NPI Number | 1962739938
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Entity Type | Organization
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Legal Business Name | A. MATULIS, MD INC
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 21225 KELLY RD SUITE 5
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City | EASTPOINTE
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State | MI
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Zip | 48021-3100
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Country | US
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Telephone | 586-772-8686
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Fax | 586-772-4877
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Provider Business Mailing Address
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Address Line | 21225 KELLY RD SUITE 5
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City | EASTPOINTE
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State | MI
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Zip | 48021-3100
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Country | US
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Telephone | 586-772-8686
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Fax | 586-471-8837
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANATOLE C. MATULIS
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Credential | MD, PH.D
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Telephone | 313-640-0975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301405406
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License Number State | MI
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