MEDICARE: RONALD S BERNE MD SC

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	174400000X	Specialist	036108708	IL

General Provider Information

NPI Number	:	1255526927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD S BERNE MD SC

Provider Business Mailing Address
First Line	:	1733 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-4305
Country	:	US
Telephone Number	:	773-237-6666
Fax Number	:	773-237-7350

Provider Business Practice Location Address
First Line	:	1733 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-4305
Country	:	US
Telephone Number	:	773-237-6666
Fax Number	:	773-237-7350

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. RONALD S BERNE
Credential	:	M.D.
Telephone Number	:	773-237-6666

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	06/11/2008

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