Provider Demographics
NPI:1487657722
Name:MADAELIL, PHILIP THOMAS (MD, FACC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:THOMAS
Last Name:MADAELIL
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CENTER POINTE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8684
Mailing Address - Country:US
Mailing Address - Phone:931-919-2627
Mailing Address - Fax:931-919-2628
Practice Address - Street 1:111 CENTER POINTE DR STE 2
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8684
Practice Address - Country:US
Practice Address - Phone:931-919-2627
Practice Address - Fax:931-919-2628
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30683207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3827110Medicaid
TNP00989636OtherRR MEDICARE
TN6011923OtherBLUE CROSS-BLUE SHIELD
TNP00989636OtherRR MEDICARE
TN103I067736Medicare PIN