Provider Demographics
NPI:1053878215
Name:LABERGE, MATHEW ROBERT
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:ROBERT
Last Name:LABERGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 N M 33 HWY
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-9242
Mailing Address - Country:US
Mailing Address - Phone:231-268-8018
Mailing Address - Fax:
Practice Address - Street 1:1743 N M 33 HWY
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-9242
Practice Address - Country:US
Practice Address - Phone:231-268-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program