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General NPI Number Information
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NPI Number | 1619183852
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Entity Type | Individual
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Provider Name | ADRIANA CARMENZA BERMEO OVALLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST SUITE 1106
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City | CHICAGO
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State | IL
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Zip | 60612-3841
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Country | US
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Telephone | 312-942-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 W RACE AVE #3W
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City | CHICAGO
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State | IL
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Zip | 60622-6247
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Country | US
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Telephone | 312-942-4500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 57.011312
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 036.127899
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License Number State | IL
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