Provider Demographics
NPI:1275828709
Name:MADANY, STACY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:MADANY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6330 ORCHARD LAKE ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-855-3366
Mailing Address - Fax:248-855-6213
Practice Address - Street 1:9640 COMMERCE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:COMMERCE
Practice Address - State:MI
Practice Address - Zip Code:48382
Practice Address - Country:US
Practice Address - Phone:248-694-6390
Practice Address - Fax:248-694-6391
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-07-29
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Provider Licenses
StateLicense IDTaxonomies
MI5601004439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant