| Name: | Madison Medical Associates, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 30 Jan 2015 (10 years ago) |
| Entity Number: | 000-327-812 |
| Register Number: | 000327812 |
| County: | Madison |
| Place of Formation: | Madison County |
| Registered Office Street Address: | 238 AVIAN LANEMADISON, AL 35758 |
| Registered Office Street Address ZIP Code: | 35758 |
Activities
NOT PROVIDED
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538540729 | 2015-06-12 | 2015-06-12 | 3809 SULLIVAN ST, SUITE 4, MADISON, AL, 357582372, US | 3809 SULLIVAN ST, SUITE 4, MADISON, AL, 357582372, US | |||||||||||||||||||
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| Phone | +1 256-325-1160 |
| Fax | 2563250740 |
Authorized person
| Name | JOHN KALISZAK |
| Role | D.O. |
| Phone | 2563251160 |
Taxonomy
| Taxonomy Code | 207RA0401X - Addiction Medicine (Internal Medicine) Physician |
| License Number | DO882 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| KALISZAK, JOHN P | Agent |
| Name | Role |
|---|---|
| KALISZAK, JOHN PETER | Organizer |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
