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General NPI Number Information
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NPI Number | 1003837071
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Entity Type | Individual
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Provider Name | ESMERALDO E CORDOVA MD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3625 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60624
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Country | US
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Telephone | 773-522-0110
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Fax | 630-964-8397
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Provider Business Mailing Address
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Address Line | 7317 BAYBERRY LANE
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City | DARIEN
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State | IL
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Zip | 60561
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Country | US
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Telephone | 630-964-8376
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Fax | 630-964-8397
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 03652477
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License Number State | IL
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