Provider Demographics
NPI:1063953008
Name:MADISON MEDICAL SUPPLIES
Entity type:Organization
Organization Name:MADISON MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAHEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:AKRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-375-2651
Mailing Address - Street 1:2810 CROSSROADS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-7942
Mailing Address - Country:US
Mailing Address - Phone:414-375-2651
Mailing Address - Fax:608-371-1911
Practice Address - Street 1:2810 CROSSROADS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-7942
Practice Address - Country:US
Practice Address - Phone:414-375-2651
Practice Address - Fax:608-371-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies