Provider Demographics
NPI:1356398358
Name:MADAJ, THOMAS EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:MADAJ
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 1:1245 S UTICA AVE
Mailing Address - Street 2:3RD FLOOR EAST
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4214
Mailing Address - Country:US
Mailing Address - Phone:918-382-2510
Mailing Address - Fax:918-382-2545
Practice Address - Street 1:1245 S UTICA AVE
Practice Address - Street 2:3RD FLOOR EAST
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4214
Practice Address - Country:US
Practice Address - Phone:918-382-2510
Practice Address - Fax:918-382-2545
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100090220AMedicaid
OK249425706Medicare PIN
C51941Medicare UPIN