Madonna Fabian MD PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MADONNA FABIAN MD PC

Practice address

3078 Niles Rd
Saint Joseph, MI 49085-8608

Phone

(323) 547-2155

NPI assigned

May 3, 2021

Last updated

May 18, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Madonna Fabian, MEDICAL DEGREENPI 1124438411

Title

President

Phone

(323) 547-2155

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Madonna Fabian

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1124438411
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1174106652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7320 STEVENSVILLE BARODA RD",
            "city": "STEVENSVILLE",
            "state": "MI",
            "postal_code": "491279703",
            "telephone_number": "323-547-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3078 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490858608",
            "telephone_number": "323-547-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADONNA FABIAN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "FABIAN",
        "authorized_official_first_name": "MADONNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-547-2155",
        "authorized_official_credential": "MEDICAL DEGREE"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pierre Luyckx, DPT
• Evan Lytle, D.O
• Matthew Alan Mabry, ATC, CSCS
• Rebecca Maccart
• Cheryl F Macdonald, MD
• Abigail Mae Mahoney, PA-C
• William T Makovic II, PA
• David Okeoghene Malaka, MD
• Ruth Malaka, MA, TLLP
• Tehseen Malik

• Internal Medicine Physician in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.