Active NPI
Madison Kanka
- Psychologist
- Bloomfield Hills, MI
National Provider Identifier
1891276531
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301017570
- Practice address
- 43996 Woodward Ave Ste 10
Bloomfield Hills, MI 48302-5030 - Phone
- (586) 413-4441
- Fax
- (248) 309-3198
- NPI assigned
- Aug 21, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301017570 | MI | Primary |
Addresses
Primary practice location
43996 Woodward Ave Ste 10
Bloomfield Hills, MI 48302-5030
Mailing address
10010 Woodland CT
Oak Park, MI 48237-1738
Phone (586) 413-4441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301017570 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534809600000",
"number": "1891276531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10010 WOODLAND CT",
"city": "OAK PARK",
"state": "MI",
"postal_code": "482371738",
"telephone_number": "586-413-4441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43996 WOODWARD AVE STE 10",
"city": "BLOOMFIELD HILLS",
"state": "MI",
"postal_code": "483025030",
"telephone_number": "586-413-4441",
"fax_number": "248-309-3198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANKA",
"first_name": "MADISON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-21",
"last_updated": "2018-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301017570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.