Provider Demographics
NPI:1013281278
Name:LAWRENCE MADIEFSKY,DPM,PA
Entity type:Organization
Organization Name:LAWRENCE MADIEFSKY,DPM,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADIEFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-341-8513
Mailing Address - Street 1:9750 NW 33RD STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-0000
Mailing Address - Country:US
Mailing Address - Phone:954-341-8513
Mailing Address - Fax:954-341-8514
Practice Address - Street 1:8110 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5795
Practice Address - Country:US
Practice Address - Phone:954-341-8513
Practice Address - Fax:954-341-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1602261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric