Provider Demographics
NPI:1629023650
Name:LARDIZABAL, ERNESTO IBALIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:IBALIO
Last Name:LARDIZABAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:315 S NAPERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5423
Mailing Address - Country:US
Mailing Address - Phone:630-221-0200
Mailing Address - Fax:630-384-2644
Practice Address - Street 1:11528 183RD PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9467
Practice Address - Country:US
Practice Address - Phone:708-326-1700
Practice Address - Fax:708-326-1707
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-058421208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation