Provider Demographics
NPI:1437144821
Name:MADISON, JAMES B (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:MADISON
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 1:2930 MONTUALE DR
Mailing Address - Street 2:STE C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704
Mailing Address - Country:US
Mailing Address - Phone:217-726-8252
Mailing Address - Fax:217-726-8262
Practice Address - Street 1:2930 MONTUALE DR
Practice Address - Street 2:STE C
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704
Practice Address - Country:US
Practice Address - Phone:217-726-8252
Practice Address - Fax:217-726-8262
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
684413Medicare ID - Type Unspecified
D14847Medicare UPIN