Individual
MR. JASON MENNO MADDELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SURGICAL ASSISTANT
Contact information
Practice address
2538 RAVINIA LN, WOODRIDGE, IL 60517-2218
(708) 205-7678
Mailing address
2538 RAVINIA LN, WOODRIDGE, IL 60517-2218
(708) 205-7678
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
05/14/2013
Last updated
04/13/2022
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