Healthcare Provider Details

I. General information

NPI: 1386059996
Provider Name (Legal Business Name): BHES MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14953 S VAN DYKE RD
PLAINFIELD IL
60544-5804
US

IV. Provider business mailing address

14953 S VAN DYKE RD
PLAINFIELD IL
60544-5804
US

V. Phone/Fax

Practice location:
  • Phone: 815-609-1544
  • Fax: 815-609-1670
Mailing address:
  • Phone: 815-609-1544
  • Fax: 815-609-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ROBERT BRUCKER JR.
Title or Position: MANAGER REPRESENTATIVE
Credential: PSY.D.
Phone: 630-728-4026