Jeetender Matharu MD PLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301070179 Issued in MI

Legal business name

JEETENDER MATHARU MD PLC

Practice address

7250 Dixie Hwy
Ste 100
Clarkston, MI 48346-5108

Phone

(248) 620-3500

Fax

(248) 620-3503

NPI assigned

Aug 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeetender S Matharu, M.D.NPI 1255310397

Title

Owner

Phone

(248) 620-3500

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeetender Singh Matharu, M.D.

  • Family Medicine Physician
  • Clarkston, MI
  • NPI 1255310397
  Medicare reassignment NPD Authorized official
• Ricardo Q. Cabrera, M.D.

  • Family Medicine Physician
  • Clarkston, MI
  • NPI 1801875943
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1407047780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7250 DIXIE HWY",
            "address_2": "STE 100",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483465108",
            "telephone_number": "248-620-3500",
            "fax_number": "248-620-3503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 DIXIE HWY",
            "address_2": "STE 100",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483465108",
            "telephone_number": "248-620-3500",
            "fax_number": "248-620-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEETENDER MATHARU MD PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "MATHARU",
        "authorized_official_first_name": "JEETENDER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-620-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301070179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4483424",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.