Provider Demographics
NPI:1407841414
Name:REGALADO, SIDNEY P (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:P
Last Name:REGALADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2160
Mailing Address - Fax:847-570-2942
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2160
Practice Address - Fax:847-570-2942
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1081952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH79927Medicare UPIN
ILL97246/357801Medicare ID - Type Unspecified