Basic Information
| Provider Information | |||||||||
| NPI: | 1881686111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARDO | ||||||||
| FirstName: | DIANNA | ||||||||
| MiddleName: | M.E. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 E CHICAGO AVE # 9 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122274500 | ||||||||
| FaxNumber: | 3122279784 | ||||||||
| Practice Location | |||||||||
| Address1: | 1919 E THOMAS RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029331213 | ||||||||
| FaxNumber: | 6029331214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | MD27931 | OR | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 036102322 | IL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | MD60515635 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085P0229X | 50996 | AZ | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | 036102322 | IL | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | MD60515635 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 036102322 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 044185 | 05 | AZ | MEDICAID | 036102322 | 05 | IL | MEDICAID | 1056261 | 05 | WA | MEDICAID |