Healthcare Provider Details

I. General information

NPI: 1316277817
Provider Name (Legal Business Name): ILLINOIS GASTROENTEROLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 FLETCHER DRIVE
ELGIN IL
60123-4747
US

IV. Provider business mailing address

745 FLETCHER DRIVE
ELGIN IL
60123-4747
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-1300
  • Fax: 847-888-1341
Mailing address:
  • Phone: 847-888-1300
  • Fax: 847-888-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL BERNSEN
Title or Position: PHYSICIAN
Credential: MD
Phone: 847-439-1005