Healthcare Provider Details

I. General information

NPI: 1861417610
Provider Name (Legal Business Name): ROBERT JAMES BERNARDONI M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 CLAY ST
DARLINGTON WI
53530-1225
US

IV. Provider business mailing address

PO BOX 153
DARLINGTON WI
53530-0153
US

V. Phone/Fax

Practice location:
  • Phone: 608-776-4497
  • Fax: 608-776-2317
Mailing address:
  • Phone: 608-776-2718
  • Fax: 608-776-2718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22260-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: