Healthcare Provider Details

I. General information

NPI: 1588906366
Provider Name (Legal Business Name): MARK C MADSEN DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 W PACIFIC DR
AMERICAN FORK UT
84003-1406
US

IV. Provider business mailing address

582 W PACIFIC DR
AMERICAN FORK UT
84003-1406
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-1900
  • Fax:
Mailing address:
  • Phone: 801-763-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6226838-2802
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: