Healthcare Provider Details

I. General information

NPI: 1891948394
Provider Name (Legal Business Name): MIKE THOMAS MADSEN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 NW 167TH ST
MIAMI GARDENS FL
33056-4406
US

IV. Provider business mailing address

11510 SHERIDAN ST
PEMBROKE PINES FL
33026-1428
US

V. Phone/Fax

Practice location:
  • Phone: 305-622-7575
  • Fax: 305-622-9464
Mailing address:
  • Phone: 954-438-9456
  • Fax: 305-622-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRT4532
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRT 4532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: