Healthcare Provider Details

I. General information

NPI: 1528976735
Provider Name (Legal Business Name): MADOCHT YELDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 TELEGRAPH RD
TAYLOR MI
48180-3330
US

IV. Provider business mailing address

57538 WINDHAM CT
WASHINGTON MI
48094-3173
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-5000
  • Fax:
Mailing address:
  • Phone: 586-224-9854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: