Healthcare Provider Details

I. General information

NPI: 1578487872
Provider Name (Legal Business Name): MADISON DELANEY POE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 HELEN AVE
LINCOLN PARK MI
48146-3782
US

IV. Provider business mailing address

3063 S STATE HIGHWAY 123 # 238
SEGUIN TX
78155-6936
US

V. Phone/Fax

Practice location:
  • Phone: 313-236-3903
  • Fax:
Mailing address:
  • Phone: 313-236-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: