| Doctor Name: | CHAD M MADERE |
| NPI Number: | 1124466958 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | TAP003099 |
| Business Practice Address: | 827 N Pine St Gramercy, LA - 700523659 |
| Business Phone Number: | 2258699200 |
| Business Fax Number: | 2258699241 |
| Mailing Address: | 827 N Pine St, GRAMERCY |
| State: | LA |
| Postal Code: | 700523659 |
| Phone Number: | 2258699200 |
| Fax Number: | 2258699241 |
| NPI Enumeration Date: | 06/14/2013 |
| NPI Last Update Date: | 01/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | TAP003099 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |