MEDICARE: AARON DALE MADSEN 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
1	207P00000X	Emergency Medicine Physician	11013996A	IN
2	207P00000X	Emergency Medicine Physician	A112806	CA

General Provider Information

NPI Number	:	1508035197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON DALE MADSEN M.D.

Provider Business Mailing Address
First Line	:	1776 COUNTRYSIDE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46231-3214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	I-65 21ST STREET
Second Line	:	B-401
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206
Country	:	US
Telephone Number	:	317-962-5975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	02/20/2019

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