Mattingly, Mark W

Mattingly, Mark W is an sole proprietor health care provider with primary practice located at G4007 W Court St Suite E, Flint MI 48532-3560. He recently has only one registered license in Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, which is considered as his primary health care specialty. Mattingly, Mark W can be contacted via phone (810) 732-0908.

Contact Information

Primary practice address
G4007 W Court St Suite E Flint MI 48532-3560
Phone: (810) 732-0908
Fax: (810) 732-1630
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 4301068512 Michigan

Profile Details

NPI number 1851442180
LBN Legal business name Mattingly, Mark W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 15th, 2007
Last updated Jul 9th, 2007 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851442180 NPPES
Michigan Other 4590228 MEDICAID
Michigan Other BLUE CROSS COMMUNITY MEDICAID
Michigan Other 7676408 MEDICAID
Michigan Other BLUE CROSS BLUE SHIE MEDICAID
Michigan Other 11500 MEDICAID
Michigan Other 0N53520 MEDICAID

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