Doctor Name: | DR. MICHAEL CHARLES MADISON |
NPI Number: | 1144366725 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 3547 |
Business Practice Address: | 17535 Rosbough Drive Suite 202 Middleburg Heights, OH - 441308362 |
Business Phone Number: | 4402342888 |
Business Fax Number: | |
Mailing Address: | 17535 Rosbough Drive, Suite 202 MIDDLEBURG HEIGHTS |
State: | OH |
Postal Code: | 441308362 |
Phone Number: | 4402342888 |
Fax Number: | |
NPI Enumeration Date: | 01/30/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 3547 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |