Provider Demographics
NPI:1144294042
Name:MADKINS, MICHAEL BERNARD (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BERNARD
Last Name:MADKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 GOSS ROAD
Mailing Address - Street 2:CREDENTIALS COORDINATOR/ FOX ARMY HEALTH CENTER
Mailing Address - City:REDSTONE ARSENAL
Mailing Address - State:AL
Mailing Address - Zip Code:35809-7000
Mailing Address - Country:US
Mailing Address - Phone:256-955-8888
Mailing Address - Fax:256-313-3260
Practice Address - Street 1:4100 GOSS ROAD
Practice Address - Street 2:PRIMARY CARE CLINIC FOX ARMY HEALTH CENTER
Practice Address - City:REDSTONE ARSENAL
Practice Address - State:AL
Practice Address - Zip Code:35809-7000
Practice Address - Country:US
Practice Address - Phone:256-955-8888
Practice Address - Fax:256-313-3260
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider