MEDICARE: DR. JUNIOR MACIAS MADAULA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME121764	FL

General Provider Information

NPI Number	:	1043577109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNIOR MACIAS MADAULA MD

Provider Business Mailing Address
First Line	:	500 VONDERBURG DR STE 102
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5968
Country	:	US
Telephone Number	:	813-681-5658
Fax Number	:	813-681-5250

Provider Business Practice Location Address
First Line	:	4051 UPPER CREEK DR STE 112
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6825
Country	:	US
Telephone Number	:	813-681-5658
Fax Number	:	813-681-5250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	01/08/2026

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