Active NPI
Michael Robert Madrzak, PA-C
- Surgical Physician Assistant
- Milwaukee, WI
National Provider Identifier
1528118882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 648
- Practice address
- 9000 W Wisconsin Ave
Ms #715
Milwaukee, WI 53226-3518 - Phone
- (414) 266-2638
- Fax
- (414) 266-2075
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 648 | WI | Primary |
Addresses
Primary practice location
9000 W Wisconsin Ave
Ms #715
Milwaukee, WI 53226-3518
Mailing address
9000 W Wisconsin Ave
Ms #715
Milwaukee, WI 53226-3518
Phone (414) 266-2638
Other practice location 1
9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 955-6900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528118882 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 648 | WI | MD | Acupuncturist |
Interoperability endpoints
- mmadrzak12117@direct.chw.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712534400000",
"number": "1528118882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9000 W WISCONSIN AVE",
"address_2": "MS #715",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263518",
"telephone_number": "414-266-2638",
"fax_number": "414-266-2075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9000 W WISCONSIN AVE",
"address_2": "MS #715",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263518",
"telephone_number": "414-266-2638",
"fax_number": "414-266-2075"
}
],
"practiceLocations": [
{
"address_1": "9200 W Wisconsin Ave",
"address_purpose": "LOCATION",
"city": "Milwaukee",
"state": "WI",
"postal_code": "532263522",
"country_code": "US",
"telephone_number": "414-955-6900",
"fax_number": "414-955-0079",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MADRZAK",
"first_name": "MICHAEL",
"middle_name": "ROBERT",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2024-04-08",
"certification_date": "2024-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "WI",
"license": "648",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1528118882",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.