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General NPI Number Information
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NPI Number | 1235143777
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Entity Type | Individual
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Provider Name | AARON W MADDOX M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 29201 TELEGRAPH RD STE 404S
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 248-450-3507
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Fax | 248-796-0177
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Provider Business Mailing Address
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Address Line | 29201 TELEGRAPH RD STE 404S
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City | SOUTHFIELD
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State | MI
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Zip | 48034-7647
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Country | US
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Telephone | 248-450-3507
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Fax | 248-796-0177
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301038283
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License Number State | MI
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