Provider Demographics
NPI:1588656755
Name:MADAK, ANDREW J (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:MADAK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:455 S LIVERNOIS RD
Mailing Address - Street 2:STE C22
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2583
Mailing Address - Country:US
Mailing Address - Phone:248-601-5780
Mailing Address - Fax:248-601-5784
Practice Address - Street 1:455 S LIVERNOIS RD
Practice Address - Street 2:C-23
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2578
Practice Address - Country:US
Practice Address - Phone:248-601-5780
Practice Address - Fax:248-601-5784
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2019-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110229804OtherMEDICARE RAILROAD ID NUMB
MI1156304394OtherBCBSM PROVIDER NUMBER
MI383472352OtherTAX IDENTIFICATION NUMBER