| Andrea Bazan, M.d, S.c | |
|
1600 West Dempster Street Suite #120 Park Ridge IL 60068 | |
| (847) 299-7888 | |
| (847) 299-7844 |
| Full Name | Andrea Bazan, M.d, S.c |
|---|---|
| Speciality | Internal Medicine |
| Location | 1600 West Dempster Street, Park Ridge, Illinois |
| Authorized Official Name and Position | Andrea M. Bazan (PRESIDENT) |
| Authorized Official Contact | 7735750613 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andrea Bazan, M.d, S.c 345 West 24th Place Chicago IL 60616-2229 Ph: (773) 575-0613 | Andrea Bazan, M.d, S.c 1600 West Dempster Street Suite #120 Park Ridge IL 60068 Ph: (847) 299-7888 |
| NPI Number | 1437357795 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 09/25/2012 |
| Medicare PECOS PAC ID | 3870689409 |
|---|---|
| Medicare Enrollment ID | O20071012000356 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437357795 | NPI | - | NPPES |
| 036095548 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036095548 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | 036-095548 (Illinois) | Primary |
| Provider Name | Andrea M Bazan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699871293 PECOS PAC ID: 5890754394 Enrollment ID: I20041008001315 |
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