Organization
MIDWEST PULMONARY AND SLEEP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RADA IVANOV MD (PARTNER)
(773) 481-1570
Entity
Organization
Contact information
Practice address
5600 W ADDISON ST, SUITE 304, CHICAGO, IL 60634-4401
(773) 481-1570
(773) 481-0547
Mailing address
5600 W ADDISON ST, SUITE 304, CHICAGO, IL 60634-4401
(773) 481-1570
(773) 481-0547
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619988
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/07/2007
Last updated
08/12/2011
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