Basic Information
| Provider Information | |||||||||
| NPI: | 1174517114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADHANI | ||||||||
| FirstName: | PARAG | ||||||||
| MiddleName: | ARVIND | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3331 W DEYOUNG ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629595896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189987600 | ||||||||
| FaxNumber: | 6189976680 | ||||||||
| Practice Location | |||||||||
| Address1: | 3331 W DEYOUNG ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629595896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189987600 | ||||||||
| FaxNumber: | 6189976680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 01/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036092572 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 036092572 | 05 | IL | MEDICAID |