Provider Demographics
NPI:1962739938
Name:A. MATULIS, MD INC
Entity type:Organization
Organization Name:A. MATULIS, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANATOLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATULIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:313-640-0975
Mailing Address - Street 1:21225 KELLY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3100
Mailing Address - Country:US
Mailing Address - Phone:586-772-8686
Mailing Address - Fax:586-471-8837
Practice Address - Street 1:21225 KELLY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3100
Practice Address - Country:US
Practice Address - Phone:586-772-8686
Practice Address - Fax:586-772-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014054062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2920834Medicaid
MI2920834Medicaid
05029475261Medicare PIN