Individual
ALFONSO S BARDALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
3339 W 55TH ST, CHICAGO, IL 60632-3249
(773) 471-3600
Mailing address
2551 N MILWAUKEE AVE, CHICAGO, IL 60647-2629
(773) 278-0724
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
036056659
IL
208D00000X
General Practice Physician
Primary
036056659
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81260006
PTAN
IL
Enumeration date
05/28/2006
Last updated
09/10/2014
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