Healthcare Provider Details

I. General information

NPI: 1962326512
Provider Name (Legal Business Name): ANJU MADAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N OLD WOODWARD AVE STE 200
BIRMINGHAM MI
48009-3341
US

IV. Provider business mailing address

604 HANNA ST
BIRMINGHAM MI
48009-1618
US

V. Phone/Fax

Practice location:
  • Phone: 947-237-3304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86115014
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: