Healthcare Provider Details

I. General information

NPI: 1003127028
Provider Name (Legal Business Name): SPRING L MADOSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W MAIN ST
MARQUETTE MI
49855-4651
US

IV. Provider business mailing address

107 W MAIN ST
MARQUETTE MI
49855-4651
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3988
  • Fax: 906-225-4707
Mailing address:
  • Phone: 906-225-3988
  • Fax: 906-225-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301096940
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5315057954
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: