Healthcare Provider Details

I. General information

NPI: 1215302203
Provider Name (Legal Business Name): ABRAHAM S MADANY MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24611 COOLIDGE HWY
OAK PARK MI
48237-1449
US

IV. Provider business mailing address

24611 COOLIDGE HWY
OAK PARK MI
48237-1449
US

V. Phone/Fax

Practice location:
  • Phone: 248-542-4300
  • Fax:
Mailing address:
  • Phone: 248-542-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM S MADANY
Title or Position: OWNER
Credential: MD
Phone: 248-842-4272