Provider Demographics
NPI:1093363236
Name:STEPHEN A MADRY MD
Entity Type:Organization
Organization Name:STEPHEN A MADRY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODLEWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-382-9902
Mailing Address - Street 1:27750 W IL ROUTE 22 STE 230
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1924
Mailing Address - Country:US
Mailing Address - Phone:847-382-9902
Mailing Address - Fax:
Practice Address - Street 1:27750 W IL ROUTE 22 STE 230
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1924
Practice Address - Country:US
Practice Address - Phone:847-382-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty