Individual
DR. ANDREW J MADAK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
455 S LIVERNOIS RD, C-23, ROCHESTER HILLS, MI 48307-2578
(248) 601-5780
(248) 601-5784
Mailing address
455 S LIVERNOIS RD, STE C22, ROCHESTER HILLS, MI 48307-2583
(248) 601-5780
(248) 601-5784
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101012535
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110229804
MEDICARE RAILROAD ID NUMB
MI
01
—
1156304394
BCBSM PROVIDER NUMBER
MI
01
—
383472352
TAX IDENTIFICATION NUMBER
MI
Enumeration date
08/16/2005
Last updated
03/13/2019
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