Provider Demographics
NPI:1235666918
Name:BANGERT, MADISON (MD)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:
Last Name:BANGERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E 9TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2877
Mailing Address - Country:US
Mailing Address - Phone:801-507-7781
Mailing Address - Fax:
Practice Address - Street 1:370 E 9TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2877
Practice Address - Country:US
Practice Address - Phone:801-507-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14004170-1205207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease