Provider Demographics
NPI:1063646560
Name:MICHAEL R. MADOW, M.D., LTD.
Entity Type:Organization
Organization Name:MICHAEL R. MADOW, M.D., LTD.
Other - Org Name:MICHAEL R. MADOW, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MADOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD, LTD
Authorized Official - Phone:702-269-7401
Mailing Address - Street 1:3033 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3838
Mailing Address - Country:US
Mailing Address - Phone:702-269-7401
Mailing Address - Fax:702-269-7406
Practice Address - Street 1:3033 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3838
Practice Address - Country:US
Practice Address - Phone:702-269-7401
Practice Address - Fax:702-269-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV10005000158Medicaid
NV37606Medicare PIN
NVB65231Medicare UPIN