Basic Information
| Provider Information | |||||||||
| NPI: | 1710192125 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLOOMGARDEN | ||||||||
| FirstName: | EVE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2151 WAUKEGAN RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | BANNOCKBURN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600151868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476638540 | ||||||||
| FaxNumber: | 8476631015 | ||||||||
| Practice Location | |||||||||
| Address1: | 2151 WAUKEGAN RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | BANNOCKBURN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600151868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476638540 | ||||||||
| FaxNumber: | 8476631015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 036133171 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.