Individual
PHILIP THOMAS MADAELIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.C.
Contact information
Practice address
111 CENTER POINTE DR STE 2, CLARKSVILLE, TN 37040-8684
(931) 919-2627
(931) 919-2628
Mailing address
111 CENTER POINTE DR STE 2, CLARKSVILLE, TN 37040-8684
(931) 919-2627
(931) 919-2628
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
30683
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3827110
—
TN
01
—
6011923
BLUE CROSS-BLUE SHIELD
TN
01
—
P00989636
RR MEDICARE
TN
Enumeration date
05/31/2005
Last updated
10/05/2022
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