Healthcare Provider Details

I. General information

NPI: 1407391774
Provider Name (Legal Business Name): BRIDGEVIEW PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7283 W 87TH ST
BRIDGEVIEW IL
60455-1821
US

IV. Provider business mailing address

7283 W 87TH ST
BRIDGEVIEW IL
60455-1821
US

V. Phone/Fax

Practice location:
  • Phone: 708-907-3862
  • Fax: 708-741-7327
Mailing address:
  • Phone: 708-907-3862
  • Fax: 708-741-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ABDELKADER ABDELJABER
Title or Position: PRESIDENT
Credential:
Phone: 217-778-7327