Healthcare Provider Details

I. General information

NPI: 1750801031
Provider Name (Legal Business Name): MADISON KOCHER WULFECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W OAKLAND PARK BLVD
LAUDERDALE LAKES FL
33313-1503
US

IV. Provider business mailing address

GENERAL SURGERY CLINIC 1801 SUNSET DRIVE
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 954-735-6000
  • Fax:
Mailing address:
  • Phone: 803-434-4166
  • Fax: 803-434-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number92863
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number308820
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL41098
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME154441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: