Individual
MICHAEL MADIEVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5525 ETIWANDA AVE STE 110, TARZANA, CA 91356-3642
(818) 996-4796
(844) 406-5413
Mailing address
5525 ETIWANDA AVE STE 110, TARZANA, CA 91356-3642
(818) 996-4796
(844) 406-5413
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
A65040
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A65040
—
CA
Enumeration date
08/18/2005
Last updated
05/12/2020
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