MEDICARE: MADISON BOUR

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	207P00000X	Emergency Medicine Physician	34.018567	OH
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518727288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON BOUR

Provider Business Mailing Address
First Line	:	2213 CHERRY ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2603
Country	:	US
Telephone Number	:	859-957-4348
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 CHERRY ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2603
Country	:	US
Telephone Number	:	419-251-4724
Fax Number	:

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

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	06/25/2026

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Directions to “ MADISON BOUR ” Practice Location

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