MEDICARE: CORAL D MATUS 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	207Q00000X	Family Medicine Physician	35071471	OH

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
2	142109	OTHER	MI	PRIORITY HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7155935002	OTHER	OH	CIGNA
5	344428256	OTHER	OH	BEECH STREET
6	0104383	OTHER	OH	UNITED
7	142072	OTHER	OH	CARE CHOICES
8	344428256	OTHER	MI	PHCS
9	000000030643	OTHER	OH	ANTHEM
10	5030651	OTHER	OH	AETNA
11	5030651	OTHER	MI	PPOM
12	26094	OTHER	OH	NATIONWIDE
13	6898	OTHER	MI	HPM

General Provider Information

NPI Number	:	1700882594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORAL D MATUS M.D.

Provider Business Mailing Address
First Line	:	3355 GLENDALE AVE FL 3
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2426
Country	:	US
Telephone Number	:	419-383-5555
Fax Number	:	419-383-3113

Provider Business Practice Location Address
First Line	:	3333 GLENDALE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2426
Country	:	US
Telephone Number	:	419-383-5555
Fax Number	:	419-383-3113

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	01/10/2018

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Directions to “ CORAL D MATUS M.D.” Practice Location

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