Provider Demographics
NPI:1336232461
Name:MADLENER, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:MADLENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:903 JORDAN BLASS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1325
Mailing Address - Country:US
Mailing Address - Phone:321-751-5351
Mailing Address - Fax:321-751-5370
Practice Address - Street 1:903 JORDAN BLASS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1325
Practice Address - Country:US
Practice Address - Phone:321-751-5351
Practice Address - Fax:321-751-5370
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME86688208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267338000Medicaid
FL79497YMedicare Oscar/Certification
FLH88727Medicare UPIN