Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 5901002377 | MI |
Y | 213ES0103X | Foot & Ankle Surgery | 900 | MN |
NPI | 1073810479 |
---|---|
Provider Name | Dr. Luke Matthew Madsen |
First Address | Fairmont, MN 56031-4575 |
Second Address | Fairmont, MN 56031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2011 |
Last Update Date | 17/09/2020 |