=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740499839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADSEN & HIRSCH, S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 05/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 N MIDVALE BLVD SUITE 204
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53705-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-274-5474
-----------------------------------------------------
Fax | 608-274-4461
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 N MIDVALE BLVD SUITE 204
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53705-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-274-5474
-----------------------------------------------------
Fax | 608-274-4461
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CRAIG J MADSEN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 608-274-5474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3033
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------