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NPI Code Detail

MEDICARE: LARA MADIGAN D.O.

MEDICARE: LARA MADIGAN D.O.
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
1207Q00000XFamily Medicine Physician5101015720MI

General Provider Information

NPI Number : 1548297765
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARA MADIGAN D.O.
Provider Business Mailing Address
First Line : 10223 E CHERRY BEND RD
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-7304
Country : US
Telephone Number : 231-929-7933
Fax Number :
Provider Business Practice Location Address
First Line : 10223 E CHERRY BEND RD
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-7304
Country : US
Telephone Number : 231-929-7933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 01/26/2011

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Directions to “ LARA MADIGAN D.O.” Practice Location

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