Basic Information
| Provider Information | |||||||||
| NPI: | 1710398128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIEDNY | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | CRAIG | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19229 MACK AVE STE 24 | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482362857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138845522 | ||||||||
| FaxNumber: | 3138846054 | ||||||||
| Practice Location | |||||||||
| Address1: | 11885 E 12 MILE RD STE 100A | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480933465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865761615 | ||||||||
| FaxNumber: | 5865761628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101021133 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 5101021133 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.