Healthcare Provider Details

I. General information

NPI: 1649219163
Provider Name (Legal Business Name): RONALD A MADEJ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HINES VA HOSPITAL 5TH AVE AND ROOSEVELT RD
HINES IL
60141
US

IV. Provider business mailing address

HINES VA HOSPITAL PO BOX 5000
HINES IL
60141
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax:
Mailing address:
  • Phone: 708-202-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: