Provider Demographics
NPI:1285641472
Name:BRIAN TIMOTHY MADVIG
Entity Type:Organization
Organization Name:BRIAN TIMOTHY MADVIG
Other - Org Name:ARBOR CLINICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MADVIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-462-7005
Mailing Address - Street 1:1725 S NAPERVILLE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8155
Mailing Address - Country:US
Mailing Address - Phone:630-462-7005
Mailing Address - Fax:630-462-7006
Practice Address - Street 1:1725 S NAPERVILLE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-8155
Practice Address - Country:US
Practice Address - Phone:630-462-7005
Practice Address - Fax:630-462-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005079103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty