MEDICARE: DAVID J. BORDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00430371	OTHER		RAILROAD MCR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184624298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J. BORDO MD

Provider Business Mailing Address
First Line	:	520 E 22ND ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6110
Country	:	US
Telephone Number	:	630-874-2542
Fax Number	:	630-874-2642

Provider Business Practice Location Address
First Line	:	5645 W ADDISON ST
Second Line	:	OUR LADY OF THE RESURECTION HOSPITAL
City	:	CHICAGO
State	:	IL
Zip	:	60634-4403
Country	:	US
Telephone Number	:	773-282-7000
Fax Number	:	773-794-7664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	01/16/2008

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Directions to “ DAVID J. BORDO MD” Practice Location

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