Provider Demographics
NPI:1629245048
Name:PARDO, JACQUELINE D (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:D
Last Name:PARDO
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 1:5737 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1507
Mailing Address - Country:US
Mailing Address - Phone:773-702-9800
Mailing Address - Fax:773-702-2011
Practice Address - Street 1:5737 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1507
Practice Address - Country:US
Practice Address - Phone:773-702-9800
Practice Address - Fax:773-702-2011
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0771142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry