Individual
DR. SHANE JORGEN MADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-5121
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-5121
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
11233
ND
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
4301088649
MI
Other
Enumeration date
05/02/2007
Last updated
03/29/2022
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