Provider Demographics
NPI:1427420066
Name:MONK, MADISON M (PA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:M
Last Name:MONK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MADISOM
Other - Middle Name:M
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:880 W CENTRAL RD STE 6200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2378
Mailing Address - Country:US
Mailing Address - Phone:847-618-0730
Mailing Address - Fax:847-618-0799
Practice Address - Street 1:880 W CENTRAL RD STE 6200
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2378
Practice Address - Country:US
Practice Address - Phone:847-618-0730
Practice Address - Fax:847-618-0799
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015033746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL85006225OtherSTATE LICENSE