MEDICARE: DR. MICHEL MATOUK M.D.,DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN15692	FL

General Provider Information

NPI Number	:	1669419461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHEL MATOUK M.D.,DDS

Provider Business Mailing Address
First Line	:	2600 E COMMERCIAL BLVD
Second Line	:	SUITE 200
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4125
Country	:	US
Telephone Number	:	954-566-0300
Fax Number	:	954-566-9066

Provider Business Practice Location Address
First Line	:	2600 E COMMERCIAL BLVD
Second Line	:	SUITE 200
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4125
Country	:	US
Telephone Number	:	954-566-0300
Fax Number	:	954-566-9066

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/02/2015

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