Provider Demographics
NPI:1003292459
Name:MADRIGAL, JOSE JR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MADRIGAL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1125
Mailing Address - Country:US
Mailing Address - Phone:219-947-6085
Mailing Address - Fax:219-947-6356
Practice Address - Street 1:1901 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-1125
Practice Address - Country:US
Practice Address - Phone:219-947-6085
Practice Address - Fax:219-947-6356
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000657A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer