Provider Demographics
NPI:1245229277
Name:MADFIS, VADIM LEV (MD)
Entity Type:Individual
Prefix:DR
First Name:VADIM
Middle Name:LEV
Last Name:MADFIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6320 SAINT AUGUSTINE RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2800
Mailing Address - Country:US
Mailing Address - Phone:904-737-6200
Mailing Address - Fax:904-737-6001
Practice Address - Street 1:6320 SAINT AUGUSTINE RD
Practice Address - Street 2:UNIT 12
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2813
Practice Address - Country:US
Practice Address - Phone:904-737-6200
Practice Address - Fax:904-737-6001
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME82655207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110236096OtherRAILROAD MEDICARE
FL06964OtherBLUE CROSS BLUE SHIELD
FL264616100Medicaid
FL105540OtherHUMANA
FL5866568OtherAETNA
FL06964OtherBLUE CROSS BLUE SHIELD
FL06964Medicare ID - Type Unspecified