DR. MATTHEW LICERALDE ELLOSO M.D.
NPI 1447563150
Internal Medicine in Grand Rapids, MI

Q: What is Matthew Elloso's NPI number?

The NPI number for Matthew Elloso is 1447563150. It was assigned to this individual provider in the NPPES registry on July 22, 2010.

Q: What is Matthew Elloso's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Matthew Elloso was last updated on June 28, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 22, 2010

100 MICHIGAN ST NE, SUITE A721, GRAND RAPIDS, MI 49503(616) 391-3139(616) 391-3044 Get Directions Write a Review

NPPES record last updated: June 28, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 28, 2021, Mar 5, 2021 (2 updates tracked since 2021).

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About Dr. Matthew Liceralde Elloso M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MATTHEW LICERALDE ELLOSO M.D. (NPI 1447563150) is an individual internal medicine provider in Grand Rapids, Michigan, licensed in Michigan (4301096516) and active in the NPI registry since July 2010.

NPPES Registry Identity

NPI1447563150

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameDR. MATTHEW LICERALDE ELLOSOCredential: M.D.

Location Address100 MICHIGAN ST NE, SUITE A721Grand Rapids, MI 49503-2560

Mailing Address100 Michigan St Ne, Mc 845Grand Rapids, MI 49503-2560

Phone(616) 391-3139

Fax(616) 391-3044

Sole ProprietorNo

Enumeration DateJuly 22, 2010

Last NPPES UpdateJune 28, 20212 updates tracked since enumeration

NPPES CertifiedJune 28, 2021

✔ NPI 1447563150 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in MI · 4301096516

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

100 MICHIGAN ST NE, Grand Rapids, MI 49503

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