1700882594 NPI number — CORAL D MATUS M.D.

Table of content: CORAL D MATUS M.D. (NPI 1700882594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700882594 NPI number — CORAL D MATUS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATUS
Provider First Name:
CORAL
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1700882594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 GLENDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43614-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-383-5555
Provider Business Practice Location Address Fax Number:
419-383-3113
Provider Enumeration Date:
06/27/2005

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: 207Q00000X , with the licence number:  35071471 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000030643 . This is a "ANTHEM MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 142109 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2071092 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7155935002 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 344428256 . This is a "BEECH STREET" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0104383 . This is a "UNITED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 142072 . This is a "CARE CHOICES" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 344428256 . This is a "PHCS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000030643 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5030651 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5030651 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 26094 . This is a "NATIONWIDE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6898 . This is a "HPM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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