Basic Information
| Provider Information | |||||||||
| NPI: | 1700882594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATUS | ||||||||
| FirstName: | CORAL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3355 GLENDALE AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193835555 | ||||||||
| FaxNumber: | 4193833113 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 GLENDALE AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193835555 | ||||||||
| FaxNumber: | 4193833113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 01/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35071471 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000030643 | 01 | OH | ANTHEM MEDICAID | OTHER | 142109 | 01 | MI | PRIORITY HEALTH | OTHER | 2071092 | 05 | OH | MEDICAID | 7155935002 | 01 | OH | CIGNA | OTHER | 344428256 | 01 | OH | BEECH STREET | OTHER | 0104383 | 01 | OH | UNITED | OTHER | 142072 | 01 | OH | CARE CHOICES | OTHER | 344428256 | 01 | MI | PHCS | OTHER | 000000030643 | 01 | OH | ANTHEM | OTHER | 5030651 | 01 | OH | AETNA | OTHER | 5030651 | 01 | MI | PPOM | OTHER | 26094 | 01 | OH | NATIONWIDE | OTHER | 6898 | 01 | MI | HPM | OTHER |