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1467427591

NPI Code Detail

MEDICARE: ELAINE MARY MADER MD

MEDICARE: ELAINE MARY MADER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	16786	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467427591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE MARY MADER MD

Provider Business Mailing Address
First Line	:	200 2ND AVE SW
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354-6830
Country	:	US
Telephone Number	:	918-542-6611
Fax Number	:	405-553-5633

Provider Business Practice Location Address
First Line	:	200 2ND AVE SW
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354-6830
Country	:	US
Telephone Number	:	918-542-6611
Fax Number	:	405-553-5633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	04/22/2008

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Directions to “ ELAINE MARY MADER MD” Practice Location

Language	Start Address	Practice Location

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