Healthcare Provider Details

I. General information

NPI: 1780099960
Provider Name (Legal Business Name): BIANCA MADRID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W OGDEN AVE
CHICAGO IL
60612-3765
US

IV. Provider business mailing address

1969 W OGDEN AVE
CHICAGO IL
60612-3765
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-2600
  • Fax:
Mailing address:
  • Phone: 312-864-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036.148788
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: