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General NPI Number Information
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NPI Number | 1396986758
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Entity Type | Individual
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Provider Name | BRADLEY MARK ALBERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 251 E HURON ST F5-704
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City | CHICAGO
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State | IL
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Zip | 60611-2908
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Country | US
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Telephone | 312-926-8132
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 N MAGNOLIA AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60613-3870
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Country | US
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Telephone | 414-526-9605
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 125054050
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License Number State | IL
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