1457322794 NPI number — DR. ARTI MADHAVAN MD

Table of content: DR. ARTI MADHAVAN MD (NPI 1457322794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457322794 NPI number — DR. ARTI MADHAVAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADHAVAN
Provider First Name:
ARTI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DESHIKACHAR
Provider Other First Name:
ARTI
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457322794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 33729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48232-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-842-5529
Provider Business Mailing Address Fax Number:
248-539-7765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30625 RUSHMORE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48025-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-331-2715
Provider Business Practice Location Address Fax Number:
248-450-5580
Provider Enumeration Date:
01/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301069572 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1457322794 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225218738 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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