Provider Demographics
NPI:1083469456
Name:MADLENERHAUSUSA LLC
Entity Type:Organization
Organization Name:MADLENERHAUSUSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADLENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-806-9450
Mailing Address - Street 1:544 MURRELL ROAD
Mailing Address - Street 2:SUITE 102 PMB 156
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955
Mailing Address - Country:US
Mailing Address - Phone:321-806-9450
Mailing Address - Fax:
Practice Address - Street 1:2210 FRONT ST STE 207
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7506
Practice Address - Country:US
Practice Address - Phone:321-806-9450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty