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NPI Code Detail

MEDICARE: MADISON MEDICAL CENTER PC

MEDICARE: MADISON MEDICAL CENTER PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical LaboratoryMI

General Provider Information

NPI Number : 1467620617
Entity Type Code : Organization
Provider Name (Legal Business Name) : MADISON MEDICAL CENTER PC
Provider Business Mailing Address
First Line : 30781 STEPHENSON HWY
Second Line :
City : MADISON HTS
State : MI
Zip : 48071-1618
Country : US
Telephone Number : 248-583-8922
Fax Number : 248-583-8969
Provider Business Practice Location Address
First Line : 13409 E 14 MILE RD
Second Line :
City : STERLING HTS
State : MI
Zip : 48312-6304
Country : US
Telephone Number : 586-977-3900
Fax Number : 586-977-6084
Authorized Official
Title or Position : PRESIDENT
Name : RAM GUNABALAN
Credential : MD
Telephone Number : 248-583-8922
Provider Enumeration Date : 02/11/2008
Last Update Date : 02/11/2008

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Directions to “MADISON MEDICAL CENTER PC ” Practice Location

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