Healthcare Provider Details

I. General information

NPI: 1184939571
Provider Name (Legal Business Name): STEPHEN A. MADRY, MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 BIESTERFIELD RD # 308
ELK GROVE VLG IL
60007-7312
US

IV. Provider business mailing address

810 BIESTERFIELD RD # 308
ELK GROVE VLG IL
60007-7312
US

V. Phone/Fax

Practice location:
  • Phone: 847-382-9902
  • Fax: 847-640-6831
Mailing address:
  • Phone: 847-382-9902
  • Fax: 847-640-6831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036090205
License Number StateIL

VIII. Authorized Official

Name: STEPHEN A MADRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-382-9902