1366457749 NPI number — DR. LAURA CIBUL KORDON M.D.

Table of content: DR. LAURA CIBUL KORDON M.D. (NPI 1366457749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366457749 NPI number — DR. LAURA CIBUL KORDON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORDON
Provider First Name:
LAURA
Provider Middle Name:
CIBUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366457749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
541 N FAIRBANKS CT
Provider Second Line Business Mailing Address:
SUITE 2719
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-670-3511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
541 N FAIRBANKS CT
Provider Second Line Business Practice Location Address:
SUITE 2719
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-670-3511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1622518 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".