Healthcare Provider Details

I. General information

NPI: 1265060479
Provider Name (Legal Business Name): MADELYN ROSE RIELS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELYN ROSE BAGWELL

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 UNIVERSITY AVENUE
MONROE LA
71203
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-8266
  • Fax:
Mailing address:
  • Phone: 318-966-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO5088
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number343560
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: