Provider Demographics
NPI:1467127167
Name:JIM MADANY
Entity Type:Organization
Organization Name:JIM MADANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOENICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-689-2041
Mailing Address - Street 1:3515 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5212
Mailing Address - Country:US
Mailing Address - Phone:248-689-2041
Mailing Address - Fax:248-689-2160
Practice Address - Street 1:3515 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5212
Practice Address - Country:US
Practice Address - Phone:248-689-2041
Practice Address - Fax:248-689-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental