Healthcare Provider Details

I. General information

NPI: 1063463545
Provider Name (Legal Business Name): MADISON MEDICAL P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 CARPENTER ST
HAMTRAMCK MI
48212-9802
US

IV. Provider business mailing address

24661 COOLIDGE HWY
OAK PARK MI
48237-1449
US

V. Phone/Fax

Practice location:
  • Phone: 313-369-3379
  • Fax: 313-893-6346
Mailing address:
  • Phone: 313-369-3379
  • Fax: 313-893-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. TUSHAR TRIPATHI
Title or Position: SUPERVISOR
Credential:
Phone: 313-369-3379