Healthcare Provider Details

I. General information

NPI: 1518751916
Provider Name (Legal Business Name): MADISON PEDIATRIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E CLIFTY DR
MADISON IN
47250-4621
US

IV. Provider business mailing address

311 E CLIFTY DR
MADISON IN
47250-4621
US

V. Phone/Fax

Practice location:
  • Phone: 859-685-5325
  • Fax:
Mailing address:
  • Phone: 859-685-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW LLOYD MCROBERTS
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 859-685-5325