MEDICARE: MADISON MEDICAL PARTNERS, LLC

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	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1730790080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON MEDICAL PARTNERS, LLC

Provider Business Mailing Address
First Line	:	911 W LAS PALMARITAS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 W LAS PALMARITAS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5546
Country	:	US
Telephone Number	:	602-505-0667
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MATTHEW SHORES
Credential	:	MD
Telephone Number	:	480-414-9868

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	08/11/2020

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