Provider Demographics
NPI:1891948394
Name:MADSEN, MIKE THOMAS (RRT)
Entity type:Individual
Prefix:MR
First Name:MIKE
Middle Name:THOMAS
Last Name:MADSEN
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11510 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1428
Mailing Address - Country:US
Mailing Address - Phone:954-438-9456
Mailing Address - Fax:305-622-9464
Practice Address - Street 1:2727 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4406
Practice Address - Country:US
Practice Address - Phone:305-622-7575
Practice Address - Fax:305-622-9464
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT45322279G1100X
FLRT 45322279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care