Provider Demographics
NPI:1902435258
Name:LEDERER, MADELINE HOWREY (MD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:HOWREY
Last Name:LEDERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N KINGSBURY ST STE 130N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7457
Mailing Address - Country:US
Mailing Address - Phone:312-775-1100
Mailing Address - Fax:
Practice Address - Street 1:900 N KINGSBURY ST STE 130N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7457
Practice Address - Country:US
Practice Address - Phone:312-775-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.170733207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program