Provider Demographics
NPI:1316028996
Name:RINGSWALD, MADONNA SUE (DO)
Entity type:Individual
Prefix:DR
First Name:MADONNA
Middle Name:SUE
Last Name:RINGSWALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:1025 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9154
Practice Address - Country:US
Practice Address - Phone:502-222-1545
Practice Address - Fax:502-222-1679
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02114208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051255OtherANTHEM
KY1061235OtherPASSPORT
KY243204000OtherPASSPORT ADVANTAGE
KY64021140Medicaid
KY000000051255OtherANTHEM
KY1061235OtherPASSPORT
KY64021140Medicaid