Provider Demographics
NPI:1720438245
Name:FAM, MAGED D (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGED
Middle Name:D
Last Name:FAM
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 1:9425 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6850
Mailing Address - Country:US
Mailing Address - Phone:732-514-6247
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF KENTUCKY MEDICAL CENTER
Practice Address - Street 2:800 ROSE STREET, MN 256
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-218-0097
Practice Address - Fax:804-828-8300
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10566207T00000X
VA0116032546390200000X
IL036.164765207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program