Healthcare Provider Details

I. General information

NPI: 1629272570
Provider Name (Legal Business Name): MICHAEL MADSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
ELMENDORF AFB AK
99506-3702
US

IV. Provider business mailing address

5955 ZEAMER AVE
ELMENDORF AFB AK
99506-3702
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-2020
  • Fax:
Mailing address:
  • Phone: 907-580-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number617
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number617
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number617
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number241616
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: