Provider Demographics
NPI:1609065895
Name:PAPPALARDO, ANDREA ARLENE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ARLENE
Last Name:PAPPALARDO
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 1:303 E ARMY TRAIL RD
Mailing Address - Street 2:STE 403
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2169
Mailing Address - Country:US
Mailing Address - Phone:630-894-7083
Mailing Address - Fax:630-894-9472
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:STE 403
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-894-7083
Practice Address - Fax:630-894-9472
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILFP2667307207R00000X, 208000000X
IL036127808207K00000X, 207KA0200X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127808Medicaid