Provider Demographics
NPI:1710192125
Name:BLOOMGARDEN, EVE D (MD)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:D
Last Name:BLOOMGARDEN
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 1:2151 WAUKEGAN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1868
Mailing Address - Country:US
Mailing Address - Phone:847-663-8540
Mailing Address - Fax:847-663-1015
Practice Address - Street 1:2151 WAUKEGAN RD STE 140
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1868
Practice Address - Country:US
Practice Address - Phone:847-663-8540
Practice Address - Fax:847-663-1015
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133171207RE0101X
PAMD439070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine