Healthcare Provider Details

I. General information

NPI: 1104237635
Provider Name (Legal Business Name): CORY MADIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DRIVE MCHE-ZDM-C CARDIOLOGY SERVICE
JBSA FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DRIVE MCHE-ZDM-C CARDIOLOGY SERVICE
JBSA FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-0935
  • Fax: 210-916-3051
Mailing address:
  • Phone: 210-916-0935
  • Fax: 210-916-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number28967
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: