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NPI Code Detail

MEDICARE: BERNARD G. SCHUPBACH M.D.

MEDICARE: BERNARD G. SCHUPBACH 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
12085R0202XDiagnostic Radiology Physician036053600IL

General Provider Information

NPI Number : 1407857287
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNARD G. SCHUPBACH M.D.
Provider Business Mailing Address
First Line : 520 E 22ND ST
Second Line :
City : LOMBARD
State : IL
Zip : 60148-6110
Country : US
Telephone Number : 630-874-2542
Fax Number : 630-874-2642
Provider Business Practice Location Address
First Line : 1325 N HIGHLAND AVE
Second Line :
City : AURORA
State : IL
Zip : 60506-1449
Country : US
Telephone Number : 630-859-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 05/13/2008

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Directions to “ BERNARD G. SCHUPBACH M.D.” Practice Location

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