MEDICARE: BERNARDO DUARTE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036047859	IL
2	2086X0206X	Surgical Oncology Physician	036047859	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2221777	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164525275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARDO DUARTE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2143
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-8143
Country	:	US
Telephone Number	:	630-472-1111
Fax Number	:	630-472-1125

Provider Business Practice Location Address
First Line	:	1841 W. ARMY TRAIL RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60101
Country	:	US
Telephone Number	:	630-472-1111
Fax Number	:	773-564-5186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	10/09/2015

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Directions to “ BERNARDO DUARTE M.D.” Practice Location

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