Provider Demographics
NPI:1225130339
Name:MADEIRA, JON TONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:TONY
Last Name:MADEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2042
Mailing Address - Country:US
Mailing Address - Phone:913-499-6835
Mailing Address - Fax:413-235-6751
Practice Address - Street 1:5213 W 116TH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-2042
Practice Address - Country:US
Practice Address - Phone:913-499-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS313222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE28984Medicare UPIN