Individual
KENNETH MADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1075 N CURTIS RD STE 101, BOISE, ID 83706-1348
(208) 302-2800
(208) 302-2825
Mailing address
3810 NORTHDALE BLVD, STE 150, TAMPA, FL 33624-1871
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2018-01195
NC
208600000X
Surgery Physician
6720A
WY
2086S0129X
Vascular Surgery Physician
6720A
WY
2086S0129X
Vascular Surgery Physician
Primary
M-12372
ID
2086S0129X
Vascular Surgery Physician
ME153722
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01371657
—
CO
05
—
121692900
—
WY
Enumeration date
10/24/2005
Last updated
10/24/2023
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