MEDICARE: MR. MICHAEL T MADAJSKI

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639193790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL T MADAJSKI

Provider Business Mailing Address
First Line	:	4000 E. CHARLESTON BLVD.
Second Line	:	B230
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 E. CHARLESTON BLVD.
Second Line	:	B230
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6682
Country	:	US
Telephone Number	:	702-968-5081
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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