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General NPI Number Information
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NPI Number | 1023122215
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Entity Type | Individual
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Provider Name | MADISON SAMPLE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 7435 W TALCOTT AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3707
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Country | US
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Telephone | 773-792-5162
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Fax | 773-594-8589
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Provider Business Mailing Address
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Address Line | 444 N NORTHWEST HWY SUITE # 302
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City | PARK RIDGE
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State | IL
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Zip | 60068-3263
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Country | US
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Telephone | 847-696-9015
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Fax | 847-696-9017
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01076521A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036093157
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License Number State | IL
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