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General NPI Number Information
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NPI Number | 1841527082
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Entity Type | Organization
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Legal Business Name | ROBERT A. FAJARDO, M.D., S.C.
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 122 SO. MICHIGAN AVE. SUITE 1413
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City | CHICAGO
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State | IL
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Zip | 60603-6191
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Country | US
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Telephone | 312-922-6071
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Fax | 312-922-5656
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Provider Business Mailing Address
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Address Line | 122 SO. MICHIGAN AVE. SUITE #1413
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City | CHICAGO
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State | IL
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Zip | 60603-6191
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Country | US
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Telephone | 312-922-6071
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Fax | 312-922-5656
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT A. FAJARDO
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Credential | M.D.
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Telephone | 312-922-6071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 36-39990
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License Number State | IL
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