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General NPI Number Information
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NPI Number | 1245496694
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Entity Type | Individual
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Provider Name | BRYCE JOSEPH CHALMAR BARDEZBANIAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 4440 W 95TH ST PHYSICIAN'S OFFICE PAVILION 207
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City | OAK LAWN
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State | IL
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Zip | 60453-2600
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Country | US
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Telephone | 708-684-1562
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N LA SALLE DR #3803
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City | CHICAGO
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State | IL
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Zip | 60654-8539
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Country | US
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Telephone | 312-213-8255
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036122093
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License Number State | IL
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