Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. PHILIP ALEXANDER MATAVERDE, D.O.
ActiveDR. PHILIP ALEXANDER MATAVERDE, D.O. is a Sports Medicine (IM) healthcare provider located in PORTAGE, Michigan. NPI 1992996458 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine (IM) · PORTAGE, MI
Registration Details
- NPI Number
- 1992996458
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 8, 2007 (19.049834872836 yrs)
- Last Updated
- Nov 27, 2023
- Licenses
-
L1865858 (MI)2012020702 (MO)2012020702 (MO)5101017269 (MI)
Practice Information
- Address
-
3200 W CENTRE AVE STE 203PORTAGE, MI, 490244889Browse MI providers · Browse ZIP 49024
- Phone
- 2693499745
- Primary Specialty
-
Sports Medicine (IM)
207RS0012X
- Additional Specialty
- Neurology
- Additional Specialty
- Sleep Medicine (Psychiatry)
- Additional Specialty
- Sports Medicine (IM)
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.