Healthcare Provider Details

I. General information

NPI: 1265181481
Provider Name (Legal Business Name): JOHN CERNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JACK CERNE MD

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

1307 OLD DOMINION RD
NAPERVILLE IL
60540-7017
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-6730
  • Fax:
Mailing address:
  • Phone: 630-901-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: