MEDICARE: MR. MIKE THOMAS MADSEN RRT

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	2279G1100X	General Care Registered Respiratory Therapist	RT4532	FL
2	2279G1100X	General Care Registered Respiratory Therapist	RT 4532	FL

General Provider Information

NPI Number	:	1891948394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIKE THOMAS MADSEN RRT

Provider Business Mailing Address
First Line	:	11510 SHERIDAN ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-1428
Country	:	US
Telephone Number	:	954-438-9456
Fax Number	:	305-622-9464

Provider Business Practice Location Address
First Line	:	2727 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4406
Country	:	US
Telephone Number	:	305-622-7575
Fax Number	:	305-622-9464

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

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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