Mataverde, Philip Alexander
Mataverde, Philip Alexander is an individual health care provider with primary practice located at 3200 W Centre Ave Ste 203 , Portage MI 49024-4889. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Sleep Medicine. Allopathic & Osteopathic Physicians / Sleep Medicine is his primary health care specialty. Mataverde, Philip Alexander can be contacted via phone (269) 349-9745.Contact Information
Primary practice address
3200 W Centre Ave Ste 203
Portage MI 49024-4889
Phone: (269) 349-9745
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | L1865858 | Michigan |
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 2012020702 | Missouri |
| Allopathic & Osteopathic Physicians / Sleep Medicine | 2084S0012X | 2012020702 | Missouri |
| Allopathic & Osteopathic Physicians / Sleep Medicine | 207RS0012X | 5101017269 | Michigan |
Profile Details
| NPI number | 1992996458 |
|---|---|
| LBN Legal business name | Mataverde, Philip Alexander |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 8th, 2007 |
| Last updated | Nov 27th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992996458 | NPPES |
| Missouri | Other | P01092598 | RAILROAD MEDICARE PTAN |
| Missouri | MEDICAID | 1992996458 | RAILROAD MEDICARE PTAN |
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