Healthcare Provider Details

I. General information

NPI: 1417376492
Provider Name (Legal Business Name): MADONNA HO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD # 111G
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1601 SW ARCHER RD # 111G
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 352-548-6000
  • Fax: 352-384-7683
Mailing address:
  • Phone: 352-548-6000
  • Fax: 352-384-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA141943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: