Provider Demographics
NPI:1184645749
Name:ARDON, MARJORIE S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:S
Last Name:ARDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7S430 DONWOOD TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9437
Mailing Address - Country:US
Mailing Address - Phone:630-369-9280
Mailing Address - Fax:
Practice Address - Street 1:7S430 DONWOOD TRAILS DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9437
Practice Address - Country:US
Practice Address - Phone:630-369-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360439052084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043905Medicaid
ILC45327Medicare UPIN
IL036043905Medicaid