1518049626 NPI number — DONALD MADUZIA OD

Table of content: DONALD MADUZIA OD (NPI 1518049626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518049626 NPI number — DONALD MADUZIA OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADUZIA
Provider First Name:
DONALD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518049626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 RAILROAD DRIVE
Provider Second Line Business Mailing Address:
DONALD MADUZIA OD
Provider Business Mailing Address City Name:
CLARENDON HILLS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-323-3202
Provider Business Mailing Address Fax Number:
630-321-0512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 RAILROAD DRIVE
Provider Second Line Business Practice Location Address:
DONALD MADUZIA OD
Provider Business Practice Location Address City Name:
CLARENDON HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-323-3202
Provider Business Practice Location Address Fax Number:
630-321-0512
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  046007789 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1700052834 . This is a "MEDICARE DURABLE GOODS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2284078 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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