Healthcare Provider Details

I. General information

NPI: 1457495707
Provider Name (Legal Business Name): KAREN SUE BERNSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST SUITE 2E
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

840 S WOOD ST M/C 856
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7416
  • Fax: 312-412-8778
Mailing address:
  • Phone: 312-413-1957
  • Fax: 312-413-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036118446
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD034893
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036118446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: