Provider Demographics
NPI:1215200670
Name:TACADENA, MA SALOME MADRIAGA (MD)
Entity Type:Individual
Prefix:DR
First Name:MA SALOME
Middle Name:MADRIAGA
Last Name:TACADENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3098 ROSEBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5640
Mailing Address - Country:US
Mailing Address - Phone:708-492-0418
Mailing Address - Fax:708-492-0418
Practice Address - Street 1:3098 ROSEBROOK CIR
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5640
Practice Address - Country:US
Practice Address - Phone:708-492-0418
Practice Address - Fax:708-492-0418
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.052513207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology