Provider Demographics
NPI:1649546441
Name:REDLEY, BALFOUR GEORGE
Entity type:Individual
Prefix:
First Name:BALFOUR
Middle Name:GEORGE
Last Name:REDLEY
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 1:9303 S VANDERPOEL AVE
Mailing Address - Street 2:SUITE B100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-5853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9303 S VANDERPOEL AVE
Practice Address - Street 2:SUITE B100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-5853
Practice Address - Country:US
Practice Address - Phone:773-595-0505
Practice Address - Fax:773-233-9010
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver