1467493668 NPI number — DR. STEVEN G BARDFIELD MD

Table of content: DR. STEVEN G BARDFIELD MD (NPI 1467493668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467493668 NPI number — DR. STEVEN G BARDFIELD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARDFIELD
Provider First Name:
STEVEN
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1467493668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 W OGDEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINSDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60521-3186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-323-6116
Provider Business Mailing Address Fax Number:
630-323-6169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
WESTMONT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60559-6135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-920-2350
Provider Business Practice Location Address Fax Number:
630-920-2381
Provider Enumeration Date:
06/09/2006

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: 208100000X , with the licence number:  036095747 , 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)





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