Individual
DR. ANDREA M. BAZAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-095548
—
IL
05
—
036095548
—
IL
Enumeration date
09/15/2006
Last updated
12/20/2021
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