Provider Demographics
NPI:1174707525
Name:ORLANDO MATIAS DO PC
Entity type:Organization
Organization Name:ORLANDO MATIAS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:O
Authorized Official - Last Name:MATIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-220-4507
Mailing Address - Street 1:2104 JOLLY RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6043
Mailing Address - Country:US
Mailing Address - Phone:517-220-4507
Mailing Address - Fax:517-575-6869
Practice Address - Street 1:2104 JOLLY RD
Practice Address - Street 2:SUITE 290
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6043
Practice Address - Country:US
Practice Address - Phone:517-220-4507
Practice Address - Fax:517-575-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON91300Medicare PIN