Provider Demographics
NPI:1609862267
Name:MADDALOZZO, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MADDALOZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E. CHICAGO AVE., #25
Mailing Address - Street 2:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2605
Mailing Address - Country:US
Mailing Address - Phone:312-227-6230
Mailing Address - Fax:
Practice Address - Street 1:225 E. CHICAGO AVE., #25
Practice Address - Street 2:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2605
Practice Address - Country:US
Practice Address - Phone:312-227-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-065457207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627123OtherBCBS PROVIDER ID
OH2386216Medicaid
IL036065457Medicaid
ILL94757Medicare PIN
IL036065457Medicaid