Healthcare Provider Details

I. General information

NPI: 1972380137
Provider Name (Legal Business Name): AMREEN BARDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 HIGHLAND AVE # 200A
DOWNERS GROVE IL
60515-2100
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-2637
US

V. Phone/Fax

Practice location:
  • Phone: 844-376-3876
  • Fax: 630-929-0633
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085-009923
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: