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General NPI Number Information
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NPI Number | 1518751916
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Entity Type | Organization
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Legal Business Name | MADISON PEDIATRIC WELLNESS CENTER
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 311 E CLIFTY DR
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City | MADISON
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State | IN
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Zip | 47250-4621
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Country | US
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Telephone | 859-685-5325
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Fax |
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Provider Business Mailing Address
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Address Line | 311 E CLIFTY DR
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City | MADISON
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State | IN
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Zip | 47250-4621
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Country | US
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Telephone | 859-685-5325
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Fax |
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. MATTHEW LLOYD MCROBERTS
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Credential | MD
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Telephone | 859-685-5325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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