Individual
MICHAEL D MADISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
500 W FORT ST, #111, BOISE, ID 83702-4501
(208) 422-1314
Mailing address
500 W FORT ST, #111, BOISE, ID 83702-4501
(208) 422-1314
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1508286790
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2014
Last updated
08/01/2017
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