Provider Demographics
NPI:1588749709
Name:MATHEWS MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:MATHEWS MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YONAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-250-9497
Mailing Address - Street 1:2221 LIVERNOIS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1603
Mailing Address - Country:US
Mailing Address - Phone:248-250-9474
Mailing Address - Fax:248-250-9483
Practice Address - Street 1:2221 LIVERNOIS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1603
Practice Address - Country:US
Practice Address - Phone:248-250-9474
Practice Address - Fax:248-250-9483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMY075033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F38151OtherBCBS
MA148498OtherGREAT LAKES HEALTH PLAN
MI57510OtherTOTAL HEALTH PLAN
MI13069OtherCAPE HEALTH PLAN
MIH88115OtherHAP
MI136976OtherCARE CHOICES
MI4696174Medicaid
MIP00296825OtherRAILROAD MEDICARE
MI4696174Medicaid
MA148498OtherGREAT LAKES HEALTH PLAN