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General NPI Number Information
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NPI Number | 1952734329
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Entity Type | Organization
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Legal Business Name | CENTER FOR MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 3240 W FRANKLIN BLVD
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City | CHICAGO
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State | IL
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Zip | 60624-1511
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Country | US
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Telephone | 773-722-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 555 W MADISON ST UNIT 901
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City | CHICAGO
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State | IL
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Zip | 60661-2514
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Country | US
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Telephone | 847-208-2282
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALFONSO S BARDALES
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Credential | M.D.
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Telephone | 847-208-2282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036-056659
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License Number State | IL
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