Healthcare Provider Details

I. General information

NPI: 1649228727
Provider Name (Legal Business Name): MARK BERNHARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 W WILSON ST STE E
BATAVIA IL
60510-7611
US

IV. Provider business mailing address

1300 WATERFORD DR LOWER LEVEL
AURORA IL
60504-5502
US

V. Phone/Fax

Practice location:
  • Phone: 630-879-5700
  • Fax:
Mailing address:
  • Phone: 630-851-1206
  • Fax: 630-820-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-068148
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: