MEDICARE: BRUCE H. HYMANSON, MD, PC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician		IL

General Provider Information

NPI Number	:	1972632446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE H. HYMANSON, MD, PC

Provider Business Mailing Address
First Line	:	5701 N ASHLAND AVE
Second Line	:	SUITE 201
City	:	CHICAGO
State	:	IL
Zip	:	60660-4027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 N ASHLAND AVE
Second Line	:	SUITE 201
City	:	CHICAGO
State	:	IL
Zip	:	60660-4027
Country	:	US
Telephone Number	:	773-728-8883
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRUCE HYMANSON
Credential	:	M.D.
Telephone Number	:	773-728-8883

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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