Individual
DR. DAVID FAVREAU FARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 W HARRISON ST, STE 400, CHICAGO, IL 60612-3841
(312) 243-4244
(312) 942-1517
Mailing address
1 WESTBROOK CORP CTR, # 240, WESTCHESTER, IL 60154-5701
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036118859
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036118859
—
IL
01
—
1633878
BCBS
IL
01
—
207067
MEDICARE PTAN LOCALITY 16
IL
01
—
207073
MEDICARE PTAN LOCALITY 15
IL
01
—
4457824
AETNA
—
Enumeration date
03/01/2006
Last updated
11/23/2009
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