Healthcare Provider Details

I. General information

NPI: 1194245167
Provider Name (Legal Business Name): MICHAEL JOSEPH MADIGAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 MEDICAL PARK RD STE 200
MOORESVILLE NC
28117-8527
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 980-302-7800
  • Fax:
Mailing address:
  • Phone: 980-302-7800
  • Fax: 336-716-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017016771
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2023-00037
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: