Healthcare Provider Details

I. General information

NPI: 1588670491
Provider Name (Legal Business Name): JOHN J BIRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 RIDGE AVE SUITE 104
EVANSTON IL
60201-2455
US

IV. Provider business mailing address

1138 JEFFREY CT W
NORTHBROOK IL
60062-4615
US

V. Phone/Fax

Practice location:
  • Phone: 847-328-2020
  • Fax:
Mailing address:
  • Phone: 847-509-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number36043033
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: