Basic Information
| Provider Information | |||||||||
| NPI: | 1821053406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADSON | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1751 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515035246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123288800 | ||||||||
| FaxNumber: | 7123288461 | ||||||||
| Practice Location | |||||||||
| Address1: | 1751 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515035246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123288800 | ||||||||
| FaxNumber: | 7123288461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-28346 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 38204 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 101178 | 01 | KS | BCBS | OTHER | 100398940A | 05 | KS | MEDICAID |