Healthcare Provider Details

I. General information

NPI: 1871642967
Provider Name (Legal Business Name): EDWARD JAMES MADLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SUNNYVIEW LANE
KALISPELL MT
59901
US

IV. Provider business mailing address

PO BOX 24823
SEATTLE WA
98124-0823
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-5111
  • Fax:
Mailing address:
  • Phone: 425-407-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4327
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: