Basic Information
| Provider Information | |||||||||
| NPI: | 1316028996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RINGSWALD | ||||||||
| FirstName: | MADONNA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950248 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024895730 | ||||||||
| FaxNumber: | 5024895753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 NEW MOODY LN | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400319154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022221545 | ||||||||
| FaxNumber: | 5022221679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 02114 | KY | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 02114 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000051255 | 01 | KY | ANTHEM | OTHER | 1061235 | 01 | KY | PASSPORT | OTHER | 243204000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 64021140 | 05 | KY | MEDICAID |