Healthcare Provider Details

I. General information

NPI: 1275509267
Provider Name (Legal Business Name): JAMES JOSEPH ANDONIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HEALTH SYSTEM 2799 WEST GRAND BOULEVARD
DETROIT MI
48202
US

IV. Provider business mailing address

30800 TELEGRAPH RD CONCENTRA
BINGHAM FARMS MI
48025
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-9106
  • Fax: 313-916-1249
Mailing address:
  • Phone: 248-712-2222
  • Fax: 248-786-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4301038002
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: