Provider Demographics
NPI:1487949921
Name:MATUSIAK, MATTHEW MICHAEL (DHSC, MT(ASCP))
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:MATUSIAK
Suffix:
Gender:M
Credentials:DHSC, MT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 KIRNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2000
Mailing Address - Country:US
Mailing Address - Phone:972-982-0912
Mailing Address - Fax:
Practice Address - Street 1:800 KIRNWOOD DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2000
Practice Address - Country:US
Practice Address - Phone:972-982-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician