Provider Demographics
NPI:1740265081
Name:MADSEN, DANIEL K (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:K
Last Name:MADSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2018
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8018
Mailing Address - Country:US
Mailing Address - Phone:740-775-7943
Mailing Address - Fax:740-947-7943
Practice Address - Street 1:13800 US RT 23 N
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690
Practice Address - Country:US
Practice Address - Phone:740-947-8602
Practice Address - Fax:740-947-7943
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0692960Medicaid
OH0692960Medicaid
OHMA0666461Medicare PIN