| Doctor Name: | DONALD JAMES MADDACK |
| NPI Number: | 1013911031 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 02001180 |
| Business Practice Address: | 3125 Willowcreek Rd Portage, IN - 463684423 |
| Business Phone Number: | 2197623175 |
| Business Fax Number: | 2197633092 |
| Mailing Address: | 3125 Willowcreek Rd, PORTAGE |
| State: | IN |
| Postal Code: | 463684423 |
| Phone Number: | 2197623175 |
| Fax Number: | 2197633092 |
| NPI Enumeration Date: | 06/08/2005 |
| NPI Last Update Date: | 03/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 02001180 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |