Organization Name: | MADISON MEDICAL CENTER PC |
NPI Number: | 1073732178 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAM GUNABALAN (PRESIDENT) |
Mailing Address: | 363 W Big Beaver Rd Suite 200 Troy |
State: | MI US |
Postal Code: | 480845220 |
Phone Number: | 2486199471 |
Fax Number: | 2486199774 |
NPI Enumeration Date: | 04/25/2007 |
NPI Last Update Date: | 10/01/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |