MEDICARE: DR. CONCEPCION E BERNABE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036057756	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001602293	OTHER	IL	IDPFR PIN

General Provider Information

NPI Number	:	1043443005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONCEPCION E BERNABE M.D.

Provider Business Mailing Address
First Line	:	855 E GOLF RD
Second Line	:	SUITE 2133
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5222
Country	:	US
Telephone Number	:	847-290-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 E GOLF RD
Second Line	:	SUITE 2133
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5222
Country	:	US
Telephone Number	:	847-290-9122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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