Jack Avedikian, MD
Individual provider Active NPI Surgery Physician · Wyandotte, MI
NPI 1194354993 · NPPES record last updated Nov 7, 2020
Key facts
- NPI
- 1194354993
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 4351046535 (MI)
- Practice address
- 2333 Biddle Ave
Wyandotte, MI 48192-4668 - Phone
- (734) 246-8004
- NPI assigned
- Apr 3, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4351046535 | MI | MD | Surgery Physician |
Interoperability endpoints
- javedikian654012@direct.hfhs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4351046535 | MI | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
2333 Biddle Ave
Wyandotte, MI 48192-4668
Mailing address
2333 Biddle Ave
Wyandotte, MI 48192-4668
Phone (734) 246-8004
Other providers in Wyandotte, MI
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- Ramy Asmaro
- Suleiman Assaf
- Mazen Wael Assal
- Ghazwan Atto
- Avortex Wellness Group LLC
- Basil Awawdeh
- Mohammad Hussein Ayoub
- Joseph Azar
- Ahmad Babaa
All providers in Wyandotte, MI · Surgery Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.