Madamala, Thakshakamani

Madamala, Thakshakamani is an individual health care provider with primary practice located at 500 Coventry Ln Suite 205, Crystal Lake IL 60014-7579. She recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as her primary health care specialty. Madamala, Thakshakamani can be contacted via phone (815) 455-7100.

Contact Information

Primary practice address
500 Coventry Ln Suite 205 Crystal Lake IL 60014-7579
Phone: (815) 455-7100
Fax: (815) 455-3951
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 036-085807 Illinois

Profile Details

NPI number 1588663843
LBN Legal business name Madamala, Thakshakamani
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2005
Last updated Jul 5th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588663843 NPPES
Illinois MEDICAID 036085807

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