Individual
KOICHI MAEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202-2608
(313) 916-2436
Mailing address
2799 W GRAND BLVD, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202-2608
(313) 916-2436
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
Primary
034888
MI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
034888
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KM034888
CHAMPUS-CHAMPUS
—
Enumeration date
01/08/2007
Last updated
09/11/2025
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