Healthcare Provider Details

I. General information

NPI: 1780242511
Provider Name (Legal Business Name): MADISYNN NOGA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7775 LAKE WORTH RD
LAKE WORTH FL
33467-2519
US

IV. Provider business mailing address

7823 OAK GROVE CIR
LAKE WORTH FL
33467-7127
US

V. Phone/Fax

Practice location:
  • Phone: 561-258-9443
  • Fax:
Mailing address:
  • Phone: 513-356-1031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135001031
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: