Provider Demographics
NPI:1457322794
Name:MADHAVAN, ARTI (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTI
Middle Name:
Last Name:MADHAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ARTI
Other - Middle Name:M
Other - Last Name:DESHIKACHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 33729
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-3729
Mailing Address - Country:US
Mailing Address - Phone:248-842-5529
Mailing Address - Fax:248-539-7765
Practice Address - Street 1:30625 RUSHMORE CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1544
Practice Address - Country:US
Practice Address - Phone:248-331-2715
Practice Address - Fax:248-450-5580
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457322794Medicaid
MI1225218738Medicaid
H12400Medicare UPIN
MIN27460005Medicare PIN