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General NPI Number Information
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NPI Number | 1720438245
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Entity Type | Individual
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Provider Name | MAGED D. FAM MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | UNIVERSITY OF KENTUCKY MEDICAL CENTER 800 ROSE STREET, MN 256
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City | LEXINGTON
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State | KY
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Zip | 40536
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Country | US
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Telephone | 859-218-0097
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Fax | 804-828-8300
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Provider Business Mailing Address
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Address Line | 9425 S MADISON ST
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City | BURR RIDGE
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State | IL
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Zip | 60527-6850
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Country | US
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Telephone | 732-514-6247
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Fax |
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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 | 036.164765
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | R-10566
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036.164765
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License Number State | IL
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