Healthcare Provider Details

I. General information

NPI: 1679679450
Provider Name (Legal Business Name): BERNARDO C LIVAS MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9462 LAWRENCE CT
SCHILLER PARK IL
60176-1552
US

IV. Provider business mailing address

9462 LAWRENCE CT
SCHILLER PARK IL
60176-1552
US

V. Phone/Fax

Practice location:
  • Phone: 847-845-4221
  • Fax:
Mailing address:
  • Phone: 847-845-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: BERNARDO C LIVAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-845-4221