Healthcare Provider Details

I. General information

NPI: 1619973765
Provider Name (Legal Business Name): JOHN DOUGLAS SADOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 03/07/2023
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PARK PL
SWANSEA IL
62226-2967
US

IV. Provider business mailing address

9 PARK PL STE B
SWANSEA IL
62226-2967
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-5722
  • Fax: 618-233-7069
Mailing address:
  • Phone: 618-233-5722
  • Fax: 618-233-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036110178
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: