Active NPI
John Anthony Medved, MD
- Family Medicine Physician
- Mundelein, IL
National Provider Identifier
1104120534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036042014
- Practice address
- 29125 N Gossell Rd
Mundelein, IL 60060-9566 - Phone
- (847) 651-4304
- Fax
- (847) 487-1099
- NPI assigned
- Dec 28, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036042014 | IL | Primary |
Addresses
Primary practice location
29125 N Gossell Rd
Mundelein, IL 60060-9566
Mailing address
29125 N Gossell Rd
Mundelein, IL 60060-9566
Phone (847) 651-4304
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036042014 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293494400000",
"number": "1104120534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29125 N GOSSELL RD",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "600609566",
"telephone_number": "847-651-4304",
"fax_number": "847-487-1099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29125 N GOSSELL RD",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "600609566",
"telephone_number": "847-651-4304",
"fax_number": "847-487-1099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDVED",
"first_name": "JOHN",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-12-28",
"last_updated": "2010-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036042014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mundelein, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.