Provider Demographics
NPI:1528024478
Name:BAUTISTA-ORDONEZ, EDEN AMBITO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:AMBITO
Last Name:BAUTISTA-ORDONEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EDEN
Other - Middle Name:B
Other - Last Name:ORDONEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1020 E OGDEN AVE STE 302
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8611
Practice Address - Country:US
Practice Address - Phone:630-355-1093
Practice Address - Fax:630-355-9390
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062992208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics