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General NPI Number Information
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NPI Number | 1992773402
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Entity Type | Individual
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Provider Name | ORLANDO O MATIAS D.O
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 2104 JOLLY RD SUITE 290
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City | OKEMOS
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State | MI
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Zip | 48864-6043
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Country | US
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Telephone | 517-220-4507
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Fax | 517-575-6869
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Provider Business Mailing Address
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Address Line | 16943 BROADVIEW DR
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City | EAST LANSING
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State | MI
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Zip | 48823-9662
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Country | US
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Telephone | 517-339-1179
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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 | 5101014979
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License Number State | MI
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