Healthcare Provider Details

I. General information

NPI: 1659320356
Provider Name (Legal Business Name): BARBARA W BAYLDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4867 N BROADWAY
CHICAGO IL
60640
US

IV. Provider business mailing address

4867 N BROADWAY
CHICAGO IL
60640
US

V. Phone/Fax

Practice location:
  • Phone: 773-561-6640
  • Fax: 773-506-4651
Mailing address:
  • Phone: 773-561-6640
  • Fax: 773-506-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: