Healthcare Provider Details

I. General information

NPI: 1376717900
Provider Name (Legal Business Name): BRIAN DOMINIC BORDINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9977 WOODS DR STE 300
SKOKIE IL
60077-1057
US

IV. Provider business mailing address

9977 WOODS DR STE 300
SKOKIE IL
60077-1057
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-8508
  • Fax:
Mailing address:
  • Phone: 847-663-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036.113918
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: