| Organization Name: | MADISON INTERNISTS P C |
| NPI Number: | 1962699843 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHAKEELA SHAKOOR (OWNER) |
| Mailing Address: | 27483 Dequindre Rd Suite 202 Madison Hts |
| State: | MI US |
| Postal Code: | 480713491 |
| Phone Number: | 2485422229 |
| Fax Number: | 2485422226 |
| NPI Enumeration Date: | 09/25/2007 |
| NPI Last Update Date: | 09/25/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 4301078037 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |