Provider Demographics
NPI:1619973765
Name:SADOFF, JOHN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:SADOFF
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 1:9 PARK PL
Mailing Address - Street 2:STE B
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2967
Mailing Address - Country:US
Mailing Address - Phone:618-233-5722
Mailing Address - Fax:618-233-7069
Practice Address - Street 1:9 PARK PL
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2967
Practice Address - Country:US
Practice Address - Phone:618-233-5722
Practice Address - Fax:618-233-7069
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110178208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO011619579OtherBNDD
IL036110178Medicaid
IL036071034OtherSUBSTANCE CONTROL
MO2003022258OtherLICENSE
IL036110178OtherLICENSE
IL036110178OtherLICENSE
MO2003022258OtherLICENSE
BS5823679OtherDEA