Provider Demographics
NPI:1780072454
Name:MADISON, ELIZABETH BARRON (MD, MA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BARRON
Last Name:MADISON
Suffix:
Gender:F
Credentials:MD, MA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2276
Mailing Address - Country:US
Mailing Address - Phone:231-487-2340
Mailing Address - Fax:
Practice Address - Street 1:560 W MITCHELL ST STE 210
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2276
Practice Address - Country:US
Practice Address - Phone:231-487-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301511878207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology