| Adnan Matta Md Pc | |
|
4090 E 14 Mile Rd Ste 100 Warren MI 48092-1196 | |
| (586) 838-4441 | |
| (586) 838-4641 |
| Full Name | Adnan Matta Md Pc |
|---|---|
| Speciality | Surgery |
| Location | 4090 E 14 Mile Rd Ste 100, Warren, Michigan |
| Authorized Official Name and Position | Adnan Halim Matta (PRESIDENT) |
| Authorized Official Contact | 5868384441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adnan Matta Md Pc 4090 E14 Mile Rd Ste 100 Warren MI 48092-1196 Ph: (586) 838-4441 | Adnan Matta Md Pc 4090 E 14 Mile Rd Ste 100 Warren MI 48092-1196 Ph: (586) 838-4441 |
| NPI Number | 1922265982 |
|---|---|
| Provider Enumeration Date | 05/19/2008 |
| Last Update Date | 01/16/2025 |
| Medicare PECOS PAC ID | 7911077060 |
|---|---|
| Medicare Enrollment ID | O20080602000794 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922265982 | NPI | - | NPPES |
| ========= | Other | MI | COMMERCIAL |
| 0206353551 | Other | MI | BCBS |
| 101701996 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 4301034389 (Michigan) | Secondary |
| 2086S0129X | Surgery - Vascular Surgery | 4301034389 (Michigan) | Primary |
| Provider Name | Adnan H Matta |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1841242815 PECOS PAC ID: 6204906357 Enrollment ID: I20080602000777 |
Peter L Wickens D.o.,p.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14050 E 14 Mile Rd, Warren, MI 48088 Phone: 586-293-2088 Fax: 586-293-5502 | |
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