Provider Demographics
NPI:1467427591
Name:MADER, ELAINE MARY (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARY
Last Name:MADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6830
Mailing Address - Country:US
Mailing Address - Phone:918-542-6611
Mailing Address - Fax:405-553-5633
Practice Address - Street 1:200 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6830
Practice Address - Country:US
Practice Address - Phone:918-542-6611
Practice Address - Fax:405-553-5633
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16786207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500156005Medicaid
OK100193100AMedicaid
OK100699440MMedicaid
MO209879907Medicaid
MO209879907Medicaid
MO500156005Medicaid
OK800522468Medicare PIN
OKDD8311Medicare PIN
248526905Medicare PIN