Organization
MADAMBA MEDICAL ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDUARDO N MADAMBA MD (PRESIDENT)
(773) 463-3632
Entity
Organization
Contact information
Practice address
1431 N WESTERN AVE, SUITE 203, CHICAGO, IL 60622-1797
(773) 278-1222
(773) 278-4598
Mailing address
5332 N KILDARE AVE, CHICAGO, IL 60630-1759
(773) 463-3632
(773) 278-4598
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
336014028
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021604377
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
05
—
036047978
—
IL
Enumeration date
09/09/2008
Last updated
09/21/2012
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