Healthcare Provider Details

I. General information

NPI: 1487162335
Provider Name (Legal Business Name): WILLIAM MADSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 MILL RD STE 10
SHEBOYGAN WI
53083-2058
US

IV. Provider business mailing address

3416 MILL RD STE 10
SHEBOYGAN WI
53083-2058
US

V. Phone/Fax

Practice location:
  • Phone: 920-451-1100
  • Fax:
Mailing address:
  • Phone: 920-451-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1544-60
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: