Healthcare Provider Details

I. General information

NPI: 1083146906
Provider Name (Legal Business Name): S MADANI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 SAINT ANTOINE ST SUITE 402
DETROIT MI
48201-1461
US

IV. Provider business mailing address

4727 SAINT ANTOINE ST SUITE 402
DETROIT MI
48201-1461
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-4629
  • Fax:
Mailing address:
  • Phone: 313-833-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAILENDER MADANI
Title or Position: OWNER
Credential: MD
Phone: 13138336429