MEDICARE: MADISON MASSOTH

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	104100000X	Social Worker	32344	MN

General Provider Information

NPI Number	:	1578245395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON MASSOTH

Provider Business Mailing Address
First Line	:	3433 BROADWAY ST NE STE 455
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2553
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 BROADWAY ST NE STE 455
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2553
Country	:	US
Telephone Number	:	612-979-2276
Fax Number	:

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

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	10/07/2025

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Directions to “ MADISON MASSOTH ” Practice Location

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