Basic Information
| Provider Information | |||||||||
| NPI: | 1508146838 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. MADOO & ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4250 N MARINE DR | ||||||||
| Address2: | SUITE 236 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606131744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734040160 | ||||||||
| FaxNumber: | 7734049876 | ||||||||
| Practice Location | |||||||||
| Address1: | 3017 N ASHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606573142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739351199 | ||||||||
| FaxNumber: | 7739351219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2011 | ||||||||
| LastUpdateDate: | 08/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | MADOO | ||||||||
| AuthorizedOfficialFirstName: | OMADATH | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3126366434 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036059405 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.