Provider Demographics
NPI:1578637138
Name:MADRY, STEPHEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:MADRY
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 1:810 BIESTERFIELD RD STE 308
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7319
Mailing Address - Country:US
Mailing Address - Phone:847-382-9902
Mailing Address - Fax:847-640-6831
Practice Address - Street 1:810 BIESTERFIELD RD STE 308
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-7319
Practice Address - Country:US
Practice Address - Phone:847-382-9902
Practice Address - Fax:847-640-6831
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-090205363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL564160Medicare ID - Type Unspecified
ILG51466Medicare UPIN