Provider Demographics
NPI:1801508593
Name:ELDRED, MADISON ANNE (PA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ANNE
Last Name:ELDRED
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:6225 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7831
Practice Address - Country:US
Practice Address - Phone:231-798-9500
Practice Address - Fax:231-798-9533
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2024-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601011489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant