Healthcare Provider Details

I. General information

NPI: 1326524810
Provider Name (Legal Business Name): IUNIA DADARLAT, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W BRADLEY PL STE 100
CHICAGO IL
60618-4716
US

IV. Provider business mailing address

PO BOX 506
NORTHBROOK IL
60065-0506
US

V. Phone/Fax

Practice location:
  • Phone: 224-306-1879
  • Fax: 224-205-3757
Mailing address:
  • Phone: 224-306-1879
  • Fax: 224-205-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: IUNIA DADARLAT
Title or Position: OWNER
Credential: MD
Phone: 224-306-1879