Provider Demographics
NPI:1225725427
Name:DACKIN, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:DACKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 SLABTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2224
Mailing Address - Country:US
Mailing Address - Phone:567-712-5796
Mailing Address - Fax:
Practice Address - Street 1:2720 SLABTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2224
Practice Address - Country:US
Practice Address - Phone:567-712-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant