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NPI Code Detail

MEDICARE: DR. MARC D BEAR M.D.

MEDICARE: DR. MARC D BEAR 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
12084P0800XPsychiatry Physician036095995IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821043290
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARC D BEAR M.D.
Provider Business Mailing Address
First Line : 2027 COLFAX ST
Second Line :
City : EVANSTON
State : IL
Zip : 60201-2531
Country : US
Telephone Number : 773-458-4671
Fax Number : 847-328-3565
Provider Business Practice Location Address
First Line : 1011 W WELLINGTON AVE
Second Line : #210
City : CHICAGO
State : IL
Zip : 60657-7187
Country : US
Telephone Number : 773-458-4671
Fax Number : 847-328-3565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 06/08/2015

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