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General NPI Number Information
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NPI Number | 1548564537
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Entity Type | Organization
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Legal Business Name | MARC D. BEAR, M.D., LLC
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 06/13/2015
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Provider Practice Location Address
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Address Line | 1011 W WELLINGTON AVE #210
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City | CHICAGO
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State | IL
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Zip | 60657-7187
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Country | US
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Telephone | 773-458-4671
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Fax | 847-328-3565
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Provider Business Mailing Address
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Address Line | 2027 COLFAX ST
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City | EVANSTON
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State | IL
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Zip | 60201-2531
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Country | US
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Telephone | 773-458-4671
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Fax | 847-328-3565
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Authorized Official
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Title or Position | PHYSICIAN/MANAGER
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Name | DR. MARC D BEAR
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Credential | M.D.
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Telephone | 773-458-4671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036-095995
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License Number State | IL
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