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NPI Code Detail

MEDICARE: ELISE MARIE MADRID M.D.

MEDICARE: ELISE MARIE MADRID M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianS1857TX
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1497138937
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISE MARIE MADRID M.D.
Provider Business Mailing Address
First Line : 5130 GATEWAY BLVD E # 51015
Second Line :
City : EL PASO
State : TX
Zip : 79905-1608
Country : US
Telephone Number : 915-215-4480
Fax Number : 915-215-5386
Provider Business Practice Location Address
First Line : 9849 KENWORTHY ST
Second Line :
City : EL PASO
State : TX
Zip : 79924-4402
Country : US
Telephone Number : 915-215-5500
Fax Number : 915-215-8655
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2015
Last Update Date : 04/20/2026

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