Amanda Matusik, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007420 Issued in MI

Practice address

34208 Van Dyke Ave
Sterling Heights, MI 48312-4647

Phone

(586) 554-7136

Fax

(586) 883-9694

NPI assigned

Aug 2, 2011

Last updated

Jul 1, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467331200000",
    "number": "1548548993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34208 VAN DYKE AVE",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483124647",
            "telephone_number": "586-554-7136",
            "fax_number": "586-883-9694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34208 VAN DYKE AVE",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483124647",
            "telephone_number": "586-554-7136",
            "fax_number": "586-883-9694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATUSIK",
        "first_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-02",
        "last_updated": "2016-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC021",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT STATE LICENSE",
            "identifier": "5601007420",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Walter Mattern, LMT
• Alison Matthews
• Crystal Matti, LMSW
• Fadi Nabeel-Georges Matti
• Silvia Matti, AGNP-C
• Trevor Maylath-Bryant
• Benjamin Charles Mayo, M.D.
• Kyuhn Antonio Maze
• Mazen Alsaqa MD PLLC
• Syed Mohsin Mohsin Mazhar, MD

• Physician Assistant in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.