MEDICARE: DR. CHARLES JAMES MATUSZAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME31583	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073618864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES JAMES MATUSZAK M.D.

Provider Business Mailing Address
First Line	:	3618 LANTANA ROAD
Second Line	:	SUITE 100
City	:	LAKE WORTH
State	:	FL
Zip	:	33462
Country	:	US
Telephone Number	:	561-296-1188
Fax Number	:	561-969-6920

Provider Business Practice Location Address
First Line	:	3618 LANTANA RD
Second Line	:	STE 100
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2246
Country	:	US
Telephone Number	:	561-296-1188
Fax Number	:	561-969-2384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	02/18/2013

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