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General NPI Number Information
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NPI Number | 1407391774
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Entity Type | Organization
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Legal Business Name | BRIDGEVIEW PEDIATRICS, P.C.
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 7283 W 87TH ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1821
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Country | US
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Telephone | 708-907-3862
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Fax | 708-741-7327
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Provider Business Mailing Address
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Address Line | 7283 W 87TH ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1821
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Country | US
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Telephone | 708-907-3862
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Fax | 708-741-7327
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Authorized Official
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Title or Position | PRESIDENT
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Name | ABDELKADER ABDELJABER
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Credential |
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Telephone | 217-778-7327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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