Basic Information
| Provider Information | |||||||||
| NPI: | 1275794448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADAN | ||||||||
| FirstName: | NIKHIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 N CENTRAL AVE | ||||||||
| Address2: | STE 1200 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024062972 | ||||||||
| FaxNumber: | 6024067586 | ||||||||
| Practice Location | |||||||||
| Address1: | 834 WALNUT ST | ||||||||
| Address2: | SUITE 650 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551671 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2008 | ||||||||
| LastUpdateDate: | 05/03/2017 | ||||||||
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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 | 207R00000X | 125052265 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | MT196393 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 52815 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 52815 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.