1609811975 NPI number — DR. VICTOR P AL-MATCHY M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609811975 NPI number — DR. VICTOR P AL-MATCHY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-MATCHY
Provider First Name:
VICTOR
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609811975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7386 VISTA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48316-5865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-635-5900
Provider Business Mailing Address Fax Number:
586-275-0066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37300 DEQUINDRE RD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48310-3591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-275-0065
Provider Business Practice Location Address Fax Number:
586-275-0066
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301070663 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4889519-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700E027480 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com