Provider Demographics
NPI:1083856553
Name:GONZALEZ, MADELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELYN
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 BISCAYNE BLVD
Mailing Address - Street 2:#307
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3155
Mailing Address - Country:US
Mailing Address - Phone:305-538-8835
Mailing Address - Fax:305-938-4044
Practice Address - Street 1:11645 BISCAYNE BLVD
Practice Address - Street 2:#307
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3155
Practice Address - Country:US
Practice Address - Phone:305-538-8835
Practice Address - Fax:305-938-4044
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107643207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002581900Medicaid
EQ172ZMedicare PIN