Provider Demographics
NPI:1235143777
Name:MADDOX, AARON W (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:W
Last Name:MADDOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH RD STE 404S
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7647
Mailing Address - Country:US
Mailing Address - Phone:248-450-3507
Mailing Address - Fax:248-796-0177
Practice Address - Street 1:29201 TELEGRAPH RD STE 404S
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-450-3507
Practice Address - Fax:248-796-0177
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0826215OtherBC/BS
MI1613285Medicaid
MI1613285Medicaid
MI0826215OtherBC/BS
A77353Medicare UPIN
MI1043221435Medicare PIN