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NPI Code Detail

MEDICARE: ALFONSO S BARDALES M.D

MEDICARE: ALFONSO S BARDALES M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician036056659IL
2207VG0400XGynecology Physician036056659IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
181260006OTHERILPTAN

General Provider Information

NPI Number : 1124075700
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALFONSO S BARDALES M.D
Provider Business Mailing Address
First Line : 2551 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2629
Country : US
Telephone Number : 773-278-0724
Fax Number :
Provider Business Practice Location Address
First Line : 3339 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-3249
Country : US
Telephone Number : 773-471-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 09/10/2014

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Directions to “ ALFONSO S BARDALES M.D” Practice Location

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