Provider Demographics
NPI:1457391930
Name:MADANI, SHAILENDER VENKATRATNAM (MD)
Entity Type:Individual
Prefix:
First Name:SHAILENDER
Middle Name:VENKATRATNAM
Last Name:MADANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 SACHIN WAY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3338
Mailing Address - Country:US
Mailing Address - Phone:586-854-2305
Mailing Address - Fax:248-717-2411
Practice Address - Street 1:888 W BIG BEAVER RD STE 404
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4761
Practice Address - Country:US
Practice Address - Phone:248-717-2410
Practice Address - Fax:248-717-2411
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059836208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics