Provider Demographics
NPI:1184790222
Name:MADANES, AMOS E (MD, FACOG)
Entity type:Individual
Prefix:DR
First Name:AMOS
Middle Name:E
Last Name:MADANES
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 N ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5304
Mailing Address - Country:US
Mailing Address - Phone:630-810-0212
Mailing Address - Fax:630-810-1027
Practice Address - Street 1:4333 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2869
Practice Address - Country:US
Practice Address - Phone:630-810-0212
Practice Address - Fax:630-810-1027
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066883174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1606654OtherBCBS PIN NUMBER
IL710020Medicare ID - Type UnspecifiedMEDICARE NUMBER
ILA54336Medicare UPIN