Provider Demographics
NPI:1487678652
Name:MCFADDEN, JEFFREY A (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:602 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2530
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-326-2856
Practice Address - Street 1:1850 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3192
Practice Address - Country:US
Practice Address - Phone:815-758-8671
Practice Address - Fax:815-758-5605
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002556A207Q00000X
IL036104766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC147HROtherBCBS OF NC
IN02002556AOtherSTATE LICENSE NUMBER
NC812085OtherPARTNERS/BLUE MEDICARE
IN02002556BOtherSTATE CONTROLLED LIC
NC5907839Medicaid
IL036104766OtherSTATE LICENSE NUMBER
IL336090764OtherSTATE CONTROLLED LICENSE
IL336090764OtherSTATE CONTROLLED LICENSE
IL036104766OtherSTATE LICENSE NUMBER
ILH42904Medicare UPIN
ILIL3270628Medicare PIN