Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Marina Matta, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1053953273

Marina Matta, PHYSICIANASSISTANT is a Physician Assistant in Grosse Pointe Farms, Michigan. Practices as a sole proprietor. Registered with an NPI since 2019.

In the registry since
2019

Practice location Address checks out

17108 Mack Ave Ste 108
Grosse Pointe Farms, MI 48230-6224
Phone: (313) 723-2572
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1053953273
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorYes
NPI enumeratedOctober 9, 2019
Last updated in NPPESFebruary 17, 2026
Certification dateFebruary 17, 2026
Mailing address17108 Mack Ave Ste 108, Grosse Pointe Farms, MI 48230-6224

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