MEDICARE: MATMED LLC

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	208VP0014X	Interventional Pain Medicine Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1992531750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATMED LLC

Provider Business Mailing Address
First Line	:	9066 SW 73RD CT PH 2404
Second Line	:
City	:	PINECREST
State	:	FL
Zip	:	33156-2972
Country	:	US
Telephone Number	:	786-808-8555
Fax Number	:	786-360-1100

Provider Business Practice Location Address
First Line	:	13302 WINDING OAK CT STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3425
Country	:	US
Telephone Number	:	786-808-8555
Fax Number	:	786-360-1100

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIGUEL ANGEL TELLERIA
Credential	:	MD, MBA
Telephone Number	:	305-205-2306

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	09/10/2024

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Directions to “MATMED LLC ” Practice Location

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