Provider Demographics
NPI:1871090795
Name:PIETERS, MATTHEW NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:NICHOLAS
Last Name:PIETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2936
Mailing Address - Country:US
Mailing Address - Phone:734-242-2727
Mailing Address - Fax:734-242-2745
Practice Address - Street 1:3677 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-4116
Practice Address - Country:US
Practice Address - Phone:313-524-0053
Practice Address - Fax:313-524-0057
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301507167207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program