Healthcare Provider Details

I. General information

NPI: 1205857695
Provider Name (Legal Business Name): BERNARD A NEMCHAUSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16W709 MARYBETH CT
WILLOWBROOK IL
60527-7052
US

IV. Provider business mailing address

PO BOX 5000 SCI/D 128
HINES IL
60141-5128
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2241
  • Fax: 708-202-7960
Mailing address:
  • Phone: 708-202-2241
  • Fax: 708-202-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: