Individual
DR. MADISON MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 E ROLLINS ST, ORLANDO, FL 32803-1248
(404) 921-8072
Mailing address
1146 DELANEY AVE, ORLANDO, FL 32806-1264
(404) 921-8072
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME166657
FL
390200000X
Student in an Organized Health Care Education/Training Program
TRN33240
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME166657
FL MEDICAL LICENSE
FL
01
—
TRN33240
TRAINING LICENSE
FL
Enumeration date
06/28/2021
Last updated
08/24/2024
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