Provider Demographics
NPI:1306133434
Name:MATWAY, TIMOTHY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:MATWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:359 ENTERPRISE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1055
Mailing Address - Country:US
Mailing Address - Phone:248-751-7246
Mailing Address - Fax:248-418-2311
Practice Address - Street 1:359 ENTERPRISE CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1055
Practice Address - Country:US
Practice Address - Phone:248-751-7246
Practice Address - Fax:248-418-2311
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099425207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN37000039Medicare PIN