Provider Demographics
NPI:1437694866
Name:MADISON, JOHN M (NP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MADISON
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Gender:M
Credentials:NP
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Mailing Address - Street 1:19401 HUBBARD DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2641
Mailing Address - Country:US
Mailing Address - Phone:313-982-8201
Mailing Address - Fax:313-982-8001
Practice Address - Street 1:19401 HUBBARD DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2641
Practice Address - Country:US
Practice Address - Phone:313-982-8201
Practice Address - Fax:313-982-8001
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
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Provider Licenses
StateLicense IDTaxonomies
MI4704293218363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care