Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036138461 | IL |
Y | 2080P0216X | Pediatric Rheumatologist | 036138461 | IL |
NPI | 1588942676 |
---|---|
Provider Name | Kaveh Ardalan |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 23/07/2015 |