MEDICARE: DR. MADOO & ASSOCIATES PC

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	207R00000X	Internal Medicine Physician	036059405	IL

General Provider Information

NPI Number	:	1508146838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MADOO & ASSOCIATES PC

Provider Business Mailing Address
First Line	:	4250 N MARINE DR
Second Line	:	SUITE 236
City	:	CHICAGO
State	:	IL
Zip	:	60613-1744
Country	:	US
Telephone Number	:	773-404-0160
Fax Number	:	773-404-9876

Provider Business Practice Location Address
First Line	:	3017 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3142
Country	:	US
Telephone Number	:	773-935-1199
Fax Number	:	773-935-1219

Authorized Official
Title or Position	:	OWNER
Name	:	DR. OMADATH B MADOO
Credential	:
Telephone Number	:	312-636-6434

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	08/18/2011

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