Individual
KURT A MADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(618) 684-1035
(618) 684-1036
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
036.144660
IL
208600000X
Surgery Physician
01038293A
IN
208600000X
Surgery Physician
036144660
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000599251
ANTHEM
IN
05
—
100318820A
—
IN
01
—
P00658239
RAILROAD MEDICARE
IN
Enumeration date
02/09/2006
Last updated
08/03/2021
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