Provider Demographics
NPI:1881688307
Name:BAWDEN, DAVID GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE
Last Name:BAWDEN
Suffix:
Gender:M
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:PO BOX 8159
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-8159
Mailing Address - Country:US
Mailing Address - Phone:847-446-7911
Mailing Address - Fax:847-386-6239
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:1200
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:847-446-7911
Practice Address - Fax:847-386-6239
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360576162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057616Medicaid
IL2160834332OtherBLUE CROSS
IL260039385OtherRAILROAD RETIREMENT
IL036057616Medicaid
IL446530Medicare ID - Type Unspecified