Healthcare Provider Details

I. General information

NPI: 1942359666
Provider Name (Legal Business Name): METRO PHYSIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26900 FRANKLIN RD
SOUTHFIELD MI
48033
US

IV. Provider business mailing address

7623 WINDGATE CIR
WEST BLOOMFIELD MI
48323-3913
US

V. Phone/Fax

Practice location:
  • Phone: 248-350-8070
  • Fax:
Mailing address:
  • Phone: 248-761-9556
  • Fax: 248-624-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301050998
License Number StateMI

VIII. Authorized Official

Name: DR. SANTHOSH MADHAVAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 248-761-9556