Healthcare Provider Details

I. General information

NPI: 1437383528
Provider Name (Legal Business Name): CLAUDIA CHERYL BOUCHER-BERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST # MC856 DEPARTMENT OF PEDIATRIC ENDOCRINOLOGY
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

840 S WOOD ST # MC856 DEPARTMENT OF PEDIATRIC ENDOCRINOLOGY
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-1795
  • Fax: 312-996-8218
Mailing address:
  • Phone: 312-996-1795
  • Fax: 312-996-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036126838
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number245144
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036126838
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: