Individual
MICHAEL ROBERT MADSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPSS
Contact information
Practice address
6239 E BROWN RD STE 105, MESA, AZ 85205-4933
(480) 477-9199
(602) 610-1556
Mailing address
6239 E BROWN RD STE 105, MESA, AZ 85205-4933
(480) 477-9199
(602) 610-1556
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609334812
—
AZ
Enumeration date
08/11/2021
Last updated
08/11/2021
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