Provider Demographics
NPI:1861444689
Name:MADDEN, MICHAEL CARL SR (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CARL
Last Name:MADDEN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 HIGHWAY 90 W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-4202
Mailing Address - Country:US
Mailing Address - Phone:251-602-1667
Mailing Address - Fax:251-602-5660
Practice Address - Street 1:7505 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618
Practice Address - Country:US
Practice Address - Phone:251-649-6112
Practice Address - Fax:251-649-6115
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL19371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
051502766OtherBCBS
AL051502767OtherBLUE CROSS BLUE SHIELD
AL051502767OtherBLUE CROSS BLUE SHIELD
051502766Medicare PIN