Healthcare Provider Details

I. General information

NPI: 1174985469
Provider Name (Legal Business Name): BEMNET HAILU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

1326 SOUTH MICHIGAN AVENUE APT 2210
CHICAGO IL
60605
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9300
  • Fax:
Mailing address:
  • Phone: 301-512-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125068043
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036-148800
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD00888962
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-148800
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: