Provider Demographics
NPI:1639287865
Name:MADSEN, JULIE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:MADSEN
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 1:7301 W EMERALD ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8688
Mailing Address - Country:US
Mailing Address - Phone:208-321-8600
Mailing Address - Fax:208-321-8626
Practice Address - Street 1:7301 W EMERALD ST
Practice Address - Street 2:STE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8688
Practice Address - Country:US
Practice Address - Phone:208-321-8600
Practice Address - Fax:208-321-8626
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7940207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDB5612OtherBLUE CROSS
ID1639287865OtherNPI
ID204186533OtherTAX I.D. NUMBER
ID1143022Medicare PIN