Provider Demographics
NPI:1730163528
Name:SALON, MATTHEW C III (MD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:C
Last Name:SALON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:C
Other - Last Name:SALON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1030 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2370
Mailing Address - Country:US
Mailing Address - Phone:231-935-0350
Mailing Address - Fax:231-932-4697
Practice Address - Street 1:1030 6TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2370
Practice Address - Country:US
Practice Address - Phone:231-935-0350
Practice Address - Fax:231-932-4697
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1099269Medicaid
MI1099269Medicaid
MI0281757Medicare ID - Type Unspecified