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Individual

GREGORY MADSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
901 MONTGOMERY ST, DECORAH, IA 52101-2325
(563) 382-2911
Mailing address
107 CRESCENT AVE, DECORAH, IA 52101-1075

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1253023
WI
363A00000X
Physician Assistant
Primary
001757
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
41962200
WI
Enumeration date
07/26/2005
Last updated
07/27/2007
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