Provider Demographics
NPI:1780145292
Name:NDAM, FANGNAN ELISHA (MD)
Entity type:Individual
Prefix:DR
First Name:FANGNAN
Middle Name:ELISHA
Last Name:NDAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:22101 MOROSS RD
Mailing Address - Street 2:PATHOLOGY DEPARTMENT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-343-3864
Mailing Address - Fax:313-881-4727
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-343-3864
Practice Address - Fax:313-881-4727
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-05-26
Deactivation Date:2019-11-04
Deactivation Code:
Reactivation Date:2022-05-24
Provider Licenses
StateLicense IDTaxonomies
MI4351049130207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology