Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 4301096327 | MI |
Y | 207PE0004X | Emergency Medical Services | P9691 | TX |
NPI | 1174842785 |
---|---|
Provider Name | Mayura Phadtare Madden |
First Address | Houston, TX 77089 |
Second Address | Houston, TX 77089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2010 |
Last Update Date | 13/01/2016 |