Provider Demographics
NPI:1588136360
Name:MADKINS, ZANTRAQUILLA Z
Entity type:Individual
Prefix:MRS
First Name:ZANTRAQUILLA
Middle Name:Z
Last Name:MADKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 SOUTH WABASH
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619
Mailing Address - Country:US
Mailing Address - Phone:855-924-9700
Mailing Address - Fax:312-809-9109
Practice Address - Street 1:7829 SOUTH WABASH
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619
Practice Address - Country:US
Practice Address - Phone:855-924-9700
Practice Address - Fax:312-809-9109
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL611933984Medicaid