MEDICARE: SIDNEY P. REGALADO M.D.

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	2085R0202X	Diagnostic Radiology Physician	036-108195	IL

General Provider Information

NPI Number	:	1407841414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY P. REGALADO M.D.

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE.
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-2160
Fax Number	:	847-570-2942

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE.
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-2160
Fax Number	:	847-570-2942

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	12/14/2018

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