Provider Demographics
NPI:1174591549
Name:HANNISH, MAJDA A (MD)
Entity type:Individual
Prefix:DR
First Name:MAJDA
Middle Name:A
Last Name:HANNISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAJDA
Other - Middle Name:A
Other - Last Name:ARAFAT-HANNISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:130 TOWN CENTER DR
Mailing Address - Street 2:STE 203
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8265
Mailing Address - Fax:248-585-8266
Practice Address - Street 1:2100 W BIG BEAVER RD
Practice Address - Street 2:STE 110
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-816-1300
Practice Address - Fax:248-816-2723
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI348604710Medicaid
MI348604710Medicaid