Provider Demographics
NPI:1245496694
Name:BARDEZBANIAN, BRYCE JOSEPH CHALMAR (MD)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:JOSEPH CHALMAR
Last Name:BARDEZBANIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 N LA SALLE DR
Mailing Address - Street 2:#3803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8539
Mailing Address - Country:US
Mailing Address - Phone:312-213-8255
Mailing Address - Fax:
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:PHYSICIAN'S OFFICE PAVILION 207
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2021-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036122093208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery