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Organization
ANDREA BAZAN, M.D, S.C
Active
Organization
ANDREA BAZAN, M.D, S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREA M. BAZAN M.D. (PRESIDENT)
(773) 575-0613
Entity
Organization
Contact information
Practice address
1600 WEST DEMPSTER STREET, SUITE #120, PARK RIDGE, IL 60068
(847) 299-7888
(847) 299-7844
Mailing address
345 WEST 24TH PLACE, CHICAGO, IL 60616-2229
(773) 575-0613
(847) 299-7844
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-095548
IL
207R00000X
Internal Medicine Physician
036095548
IL
Other
Enumeration date
07/10/2007
Last updated
09/25/2012
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