Individual
MADISON SAMPLE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7435 W TALCOTT AVE, CHICAGO, IL 60631-3707
(773) 792-5162
(773) 594-8589
Mailing address
444 N NORTHWEST HWY, SUITE # 302, PARK RIDGE, IL 60068-3263
(847) 696-9015
(847) 696-9017
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01076521A
IN
207L00000X
Anesthesiology Physician
Primary
036093157
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001620300
BLUECROSS BLUESHILD OF IL
IL
05
—
0360093157 2
—
IL
01
—
364054341
COMMERCIAL INS.GROUP#
IL
Enumeration date
08/18/2006
Last updated
10/31/2023
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