Healthcare Provider Details

I. General information

NPI: 1598685539
Provider Name (Legal Business Name): MADISON NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 GRAND CANYON DR
MADISON WI
53719-1044
US

IV. Provider business mailing address

636 GRAND CANYON DR
MADISON WI
53719-1044
US

V. Phone/Fax

Practice location:
  • Phone: 949-615-9065
  • Fax: 949-715-0188
Mailing address:
  • Phone: 949-615-9065
  • Fax: 949-715-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAT BYRNES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 949-615-9065