Provider Demographics
NPI:1912996786
Name:MADRIGAL, MARILU (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILU
Middle Name:
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 S MIAMI AVE
Mailing Address - Street 2:STE 2007
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4227
Mailing Address - Country:US
Mailing Address - Phone:305-856-4598
Mailing Address - Fax:305-856-0393
Practice Address - Street 1:3659 S MIAMI AVE
Practice Address - Street 2:STE 2007
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4227
Practice Address - Country:US
Practice Address - Phone:305-856-4598
Practice Address - Fax:305-856-0393
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062299207V00000X, 207VG0400X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32534VMedicare PIN
G43812Medicare UPIN