Provider Demographics
NPI:1649272261
Name:PADUVANA, MAJEED A (MD)
Entity type:Individual
Prefix:
First Name:MAJEED
Middle Name:A
Last Name:PADUVANA
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 1:18263 E 10 MILE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5805
Mailing Address - Country:US
Mailing Address - Phone:586-552-8696
Mailing Address - Fax:586-552-4404
Practice Address - Street 1:18263 E 10 MILE RD
Practice Address - Street 2:SUITE E
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5805
Practice Address - Country:US
Practice Address - Phone:586-552-8696
Practice Address - Fax:586-552-4404
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E031610OtherBCBS GROUP NUMBER
MI700E031610OtherBCBS GROUP NUMBER
F95488Medicare UPIN