Basic Information
| Provider Information | |||||||||
| NPI: | 1811344567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADDRELL | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ERIE COURT, SUITE 6160 | ||||||||
| Address2: | DR. A.L. BURDICK FAMILY MEDICINE CENTER | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087631490 | ||||||||
| FaxNumber: | 7087637232 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ERIE COURT, SUITE 6160 | ||||||||
| Address2: | DR. A.L. BURDICK FAMILY MEDICINE CENTER | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087631490 | ||||||||
| FaxNumber: | 7087637232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2016 | ||||||||
| LastUpdateDate: | 02/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 36148153 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.