Individual
DR. BRADLEY JENNINGS GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
850 W IRVING PARK RD STE 1, CHICAGO, IL 60613-3099
(773) 975-6775
(847) 433-8294
Mailing address
PO BOX 14537, CHICAGO, IL 60614-0537
(847) 433-8297
(847) 433-8294
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036-069850
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036069850
—
IL
01
—
31603528
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
10/24/2006
Last updated
03/19/2020
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