Individual
MARK LANE MADENWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5304 PRINCE LN, FLOWER MOUND, TX 75022-8103
(214) 734-4868
Mailing address
5304 PRINCE LN, FLOWER MOUND, TX 75022-8103
(214) 513-2800
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
J2173
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042138002
—
TX
01
—
042138003
CSHCN
TX
01
—
89532Z
BCBS
TX
Enumeration date
10/06/2005
Last updated
09/18/2015
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