Provider Demographics
NPI:1053562355
Name:BONAKDARPOUR, BORNA (MD)
Entity type:Individual
Prefix:DR
First Name:BORNA
Middle Name:
Last Name:BONAKDARPOUR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:676 N SAINT CLAIR ST STE 945
Mailing Address - Street 2:NMFF- NEUROBEHAVIOR AND MEMORY CLINIC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2952
Mailing Address - Country:US
Mailing Address - Phone:312-695-9627
Mailing Address - Fax:312-695-6072
Practice Address - Street 1:676 N SAINT CLAIR ST STE 945
Practice Address - Street 2:NMFF- NEUROBEHAVIOR AND MEMORY CLINIC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2952
Practice Address - Country:US
Practice Address - Phone:520-626-2761
Practice Address - Fax:312-695-6072
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2015-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0361311142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology