Organization
RADA I IVANOV MD SC
Active
Organization
RADA I IVANOV MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RADA I IVANOV MD (PRESIDENT)
(708) 250-1829
Entity
Organization
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(708) 250-1829
Mailing address
1516 FRANKLIN AVE, RIVER FOREST, IL 60305-1043
(708) 250-1829
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036089071
IL
Other
Enumeration date
04/13/2015
Last updated
04/13/2015
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