# ANDREA BAZAN, M.D, S.C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437357795
- **Authorized official:** DR. ANDREA M. BAZAN M.D. (PRESIDENT)
- **Authorized official phone:** (773) 575-0613

## Contact information

- **Practice address:** 1600 WEST DEMPSTER STREET, SUITE \#120, PARK RIDGE, IL 60068
- **Practice address phone:** (847) 299-7888
- **Practice address fax:** (847) 299-7844
- **Mailing address:** 345 WEST 24TH PLACE, CHICAGO, IL 60616-2229
- **Mailing address phone:** (773) 575-0613
- **Mailing address fax:** (847) 299-7844

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036-095548 | IL | Yes |
| 207R00000X | Internal Medicine Physician | 036095548 | IL | — |

## Other

- **Enumeration date:** 07/10/2007
- **Last updated:** 09/25/2012