Provider Demographics
NPI:1831217728
Name:VIDAL, PATRICIA (MD)
Entity type:Individual
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First Name:PATRICIA
Middle Name:
Last Name:VIDAL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1900 W POLK ST
Mailing Address - Street 2:SUITE 465
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-5215
Mailing Address - Fax:312-864-9542
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:CLINIC E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-7776
Practice Address - Fax:312-864-9542
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-05-04
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Provider Licenses
StateLicense IDTaxonomies
IL036091143208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology