Healthcare Provider Details

I. General information

NPI: 1477526671
Provider Name (Legal Business Name): MARTIN MADORSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 SW 87TH AVE SUITE 240
MIAMI FL
33173-5458
US

IV. Provider business mailing address

7400 SW 87TH AVE SUITE 240
MIAMI FL
33173-5458
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-6000
  • Fax: 305-598-7754
Mailing address:
  • Phone: 305-270-6000
  • Fax: 305-598-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME0019928
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0019928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: