Healthcare Provider Details

I. General information

NPI: 1942398086
Provider Name (Legal Business Name): JEFF MADIGAN L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W ELLIOTT ST
SAINT IGNACE MI
49781-1868
US

IV. Provider business mailing address

114 W ELLIOTT ST
SAINT IGNACE MI
49781-1868
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-8616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberJM002555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: