# MADONNA FABIAN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174106652
- **Authorized official:** MADONNA FABIAN MEDICAL DEGREE (PRESIDENT)
- **Authorized official phone:** (323) 547-2155

## Contact information

- **Practice address:** 3078 NILES RD, SAINT JOSEPH, MI 49085-8608
- **Practice address phone:** (323) 547-2155
- **Mailing address:** 7320 STEVENSVILLE BARODA RD, STEVENSVILLE, MI 49127-9703
- **Mailing address phone:** (323) 547-2155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2021
- **Last updated:** 05/18/2021