Provider Demographics
NPI:1194834705
Name:MADEJ, ANNA Z (M D)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:Z
Last Name:MADEJ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-8931
Mailing Address - Country:US
Mailing Address - Phone:509-837-4949
Mailing Address - Fax:509-837-2808
Practice Address - Street 1:2925 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-8931
Practice Address - Country:US
Practice Address - Phone:509-837-4949
Practice Address - Fax:509-837-2808
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9112MAOtherREGENCE PROVIDER #
WA0176020OtherLABOR & INDUSTRIES PROV #
WA8383671Medicaid
WA0176020OtherLABOR & INDUSTRIES PROV #
H98064Medicare UPIN