Provider Demographics
NPI:1629829338
Name:BORDEAU, THIBAULT
Entity Type:Individual
Prefix:
First Name:THIBAULT
Middle Name:
Last Name:BORDEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 SAVANNAH CIR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1637
Mailing Address - Country:US
Mailing Address - Phone:847-507-4758
Mailing Address - Fax:
Practice Address - Street 1:1640 SAVANNAH CIR
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1637
Practice Address - Country:US
Practice Address - Phone:847-507-4758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program