Individual provider · NPI-1

Dr. Roy James Bardwell Jr., D.O.

Family Medicine · Tinley Park, IL

NPI number1154562080
StatusActive
Last updated in NPPESJun 29, 2016

Details

NPI
1154562080
Entity type
Individual (NPI-1)
Name
Dr. Roy James Bardwell Jr.
Credential
D.O.
Sex
Male
Sole proprietor
No
Enumeration date
Mar 24, 2009
Last updated
Jun 29, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine036124712ILYes

Practice location

16650 Harlem Ave
Suite 6
Tinley Park, IL 60477-1847

Phone 708-802-9355 · Fax 708-904-4504

Mailing address

16650 Harlem Avenue
Suite 6
Tinley Park, IL 60477-7241

Phone 708-802-9355 · Fax 708-904-4504

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