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General NPI Number Information
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NPI Number | 1063463545
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Entity Type | Organization
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Legal Business Name | MADISON MEDICAL P.C
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 3120 CARPENTER ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-9802
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Country | US
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Telephone | 313-369-3379
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Fax | 313-893-6346
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Provider Business Mailing Address
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Address Line | 24661 COOLIDGE HWY
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City | OAK PARK
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State | MI
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Zip | 48237-1449
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Country | US
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Telephone | 313-369-3379
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Fax | 313-893-6346
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MR. TUSHAR TRIPATHI
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Credential |
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Telephone | 313-369-3379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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