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NPI Code Detail

MEDICARE: BERNADETTE MIETUS STEVENSON M.D., PHD

MEDICARE: BERNADETTE MIETUS STEVENSON M.D., PHD
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
12084P0800XPsychiatry Physician036125272IL

General Provider Information

NPI Number : 1134347909
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNADETTE MIETUS STEVENSON M.D., PHD
Provider Business Mailing Address
First Line : 8745 W HIGGINS RD STE 110
Second Line :
City : CHICAGO
State : IL
Zip : 60631-2753
Country : US
Telephone Number : 224-361-3301
Fax Number : 405-337-9658
Provider Business Practice Location Address
First Line : 8745 W HIGGINS RD STE 110
Second Line :
City : CHICAGO
State : IL
Zip : 60631-2753
Country : US
Telephone Number : 224-361-3301
Fax Number : 405-337-9658
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 04/24/2023

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