MEDICARE: MICHAEL R. MADOW, M.D., LTD.

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	2084P0800X	Psychiatry Physician	10109	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063646560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL R. MADOW, M.D., LTD.

Provider Business Mailing Address
First Line	:	3033 W HORIZON RIDGE PKWY
Second Line	:	SUITE 111
City	:	HENDERSON
State	:	NV
Zip	:	89052-3838
Country	:	US
Telephone Number	:	702-269-7401
Fax Number	:	702-269-7406

Provider Business Practice Location Address
First Line	:	3033 W HORIZON RIDGE PKWY
Second Line	:	SUITE 111
City	:	HENDERSON
State	:	NV
Zip	:	89052-3838
Country	:	US
Telephone Number	:	702-269-7401
Fax Number	:	702-269-7406

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. MICHAEL RICHARD MADOW
Credential	:	M.D., LTD.
Telephone Number	:	702-269-7401

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	10/19/2010

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