Provider Demographics
NPI:1346454295
Name:MENON, MADHU PARAMESWAR (MD)
Entity type:Individual
Prefix:
First Name:MADHU
Middle Name:PARAMESWAR
Last Name:MENON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43133 COVESIDE CIR
Mailing Address - Street 2:APT. 1713
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3273
Mailing Address - Country:US
Mailing Address - Phone:207-344-8555
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:PATHOLOGY K-6
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103351207ZH0000X, 207ZI0100X, 207ZP0102X
UT12066641-1205207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology