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General NPI Number Information
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NPI Number | 1104802016
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Entity Type | Individual
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Provider Name | JEFFREY D. GIRARDOT MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 801 S WASHINGTON ST
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City | NAPERVILLE
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State | IL
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Zip | 60540-7430
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Country | US
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Telephone | 630-527-3426
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Fax |
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Provider Business Mailing Address
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Address Line | 836 WOODLAWN AVE
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City | NAPERVILLE
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State | IL
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Zip | 60540-6833
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Country | US
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Telephone | 630-369-7443
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036-086322
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License Number State | IL
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