MEDICARE: MADISON YOUNG

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	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1760329700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON YOUNG

Provider Business Mailing Address
First Line	:	1336 N DAMEN AVE APT 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2298
Country	:	US
Telephone Number	:	810-922-5404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1336 N DAMEN AVE APT 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2298
Country	:	US
Telephone Number	:	810-922-5404
Fax Number	:

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

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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Directions to “ MADISON YOUNG ” Practice Location

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