Provider Demographics
NPI:1588639702
Name:JOHN, MADHU J (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:J
Last Name:JOHN
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:PO BOX 25655
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5655
Mailing Address - Country:US
Mailing Address - Phone:559-450-5500
Mailing Address - Fax:559-450-5571
Practice Address - Street 1:7130 N MILLBROOK AVE
Practice Address - Street 2:#112
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3347
Practice Address - Country:US
Practice Address - Phone:559-450-5500
Practice Address - Fax:559-450-5571
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA345792085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A345790Medicaid
CA1588639702Medicaid
CA00A345790Medicare ID - Type Unspecified
CA1588639702Medicaid
CA1588639702Medicare PIN