Provider Demographics
NPI:1851714596
Name:M A VERARDI MD PC
Entity Type:Organization
Organization Name:M A VERARDI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-821-2684
Mailing Address - Street 1:3120 FRANKTON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5072
Mailing Address - Country:US
Mailing Address - Phone:248-821-2684
Mailing Address - Fax:248-485-2060
Practice Address - Street 1:43344 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5014
Practice Address - Country:US
Practice Address - Phone:248-758-0730
Practice Address - Fax:248-758-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082523207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301082523OtherSTATE LICENSE
MI0636475OtherBLUE CARE NETWORK
MI0636475OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
MI1407039415Medicaid
MI1407039415Medicaid