Provider Demographics
NPI:1942286638
Name:MADSEN, MARI ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:ANNE
Last Name:MADSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8737 BEVERLY BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1828
Mailing Address - Country:US
Mailing Address - Phone:310-854-3580
Mailing Address - Fax:310-659-5830
Practice Address - Street 1:8737 BEVERLY BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1828
Practice Address - Country:US
Practice Address - Phone:310-854-3580
Practice Address - Fax:310-659-5830
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2012-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA92144208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A92144Medicaid
CA00A92144Medicaid
A92144Medicare ID - Type Unspecified