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1144513177 NPI number — THOMAS PHILIP MADAELIL MD

NPI Number: 1144513177
Health Care Provider/Practitioner: THOMAS PHILIP MADAELIL MD

Information about “1144513177” NPI (THOMAS PHILIP MADAELIL MD) exists in 1144513177 in HTML format HTML  |  1144513177 in plain Text format TXT  |  1144513177 in PDF (Portable Document Format) PDF  |  1144513177 in an XML format XML  formats.

NPI Number : 1144513177 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144513177",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MADAELIL",
    "FirstName": "THOMAS",
    "MiddleName": "PHILIP",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "510 S KINGSHIGHWAY BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63110-1016",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-362-5460",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "510 S KINGSHIGHWAY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63110-1016",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-362-5460",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/24/2011",
    "LastUpdateDate": "10/18/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "MT199111",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "2016009664",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085N0700X",
          "TaxonomyName": "Neuroradiology Physician",
          "LicenseNumber": "S0502",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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