Provider Demographics
NPI:1821057795
Name:MADAMBA, EDUARDO NERA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:NERA
Last Name:MADAMBA
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 1:5332 N KILDARE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1759
Mailing Address - Country:US
Mailing Address - Phone:773-278-1222
Mailing Address - Fax:773-278-4598
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1797
Practice Address - Country:US
Practice Address - Phone:773-278-1222
Practice Address - Fax:773-278-4598
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047978207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047978Medicaid
IL0021604377OtherBLUE CROSS BLUE SHIELD
IL0021604377OtherBLUE CROSS BLUE SHIELD