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General NPI Number Information
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NPI Number | 1760507156
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Entity Type | Individual
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Provider Name | ISIDRO CARDONA MED.,CADC.,NCRS
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2230 N 77TH AVE
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City | ELMWOOD PARK
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State | IL
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Zip | 60707-3014
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Country | US
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Telephone | 708-452-0865
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Fax |
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Provider Business Mailing Address
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Address Line | 1127 N OAKLEY BLVD
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City | CHICAGO
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State | IL
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Zip | 60622-3507
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Country | US
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Telephone | 312-770-3313
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17651
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 24499
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License Number State | IL
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