Provider Demographics
NPI:1275509267
Name:ANDONIAN, JAMES JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:ANDONIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30800 TELEGRAPH RD
Mailing Address - Street 2:CONCENTRA
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-712-2222
Mailing Address - Fax:248-786-6079
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:2799 WEST GRAND BOULEVARD
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-9106
Practice Address - Fax:313-916-1249
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010380022083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI485885310Medicaid
JA038002OtherCOMMERCIAL-COMMERCIAL NUMBER
JA038002OtherCHAMPUS-CHAMPUS
700H262220OtherBLUE CROSS-BLUE CROSS
JA038002OtherCOMMERCIAL-COMMERCIAL NUMBER
0H26222762Medicare ID - Type Unspecified