Individual
MARY KOMPERDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
675 W NORTH AVE, STE-210, MELROSE PARK, IL 60160-1634
(708) 450-5094
(708) 344-0508
Mailing address
675 W NORTH AVE, SUITE 210, MELROSE PARK, IL 60160-1634
(708) 450-5094
(708) 344-0508
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209-004003
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164530713
CONSULTANTS IN CARDIOVASCULAR MEDICINE, S.C. GROUP NPI NUMBER
IL
01
—
209712
MEDICARE GROUP NUMBER
IL
01
—
31602469
BLUE CROSS BLUE SHIELD GROUP PROVIDER NUMBER
IL
01
—
961280
MEDICARE GROUP NUMBER
IL
01
—
CC1592
RAILROAD MEDICARE GROUP PTAN NUMBER
IL
01
—
K18549
MEDICARE INDIVIDUAL PTAN NUMBER
IL
01
—
P00236752
RAILROAD MEDICARE INDIVIDUAL PROVIDER ID
IL
Enumeration date
05/26/2006
Last updated
08/17/2018
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