Provider Demographics
NPI:1316403876
Name:MADEJ, MICHAEL CONRAD (FNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CONRAD
Last Name:MADEJ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5998 E WALLINGS RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1536
Mailing Address - Country:US
Mailing Address - Phone:440-539-5636
Mailing Address - Fax:
Practice Address - Street 1:4125 MEDINA RD STE 200B
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-4514
Practice Address - Country:US
Practice Address - Phone:330-344-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily