Healthcare Provider Details

I. General information

NPI: 1093866147
Provider Name (Legal Business Name): MICHAEL EDWARD MADISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/03/2023
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 E STATE ST STE B
SALEM OH
44460-4409
US

IV. Provider business mailing address

2094 E STATE ST STE B
SALEM OH
44460-4409
US

V. Phone/Fax

Practice location:
  • Phone: 330-337-8709
  • Fax:
Mailing address:
  • Phone: 330-337-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35-06-9908-M
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-06-9908-M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: