Individual
DINO MADONNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
601 E DIXIE AVE, MEDICAL PLAZA 901, LEESBURG, FL 34748-5953
(352) 728-2404
(352) 787-7401
Mailing address
601 E DIXIE AVE, MEDICAL PLAZA 901, LEESBURG, FL 34748-5953
(352) 728-2404
(352) 787-7401
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
ME78248
FL
207YS0123X
Facial Plastic Surgery Physician
Primary
ME78248
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256975200
—
FL
Enumeration date
07/26/2005
Last updated
07/16/2019
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