1083743553 NPI number — BERNARD H SHULMAN MD, PC

Table of content: (NPI 1083743553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083743553 NPI number — BERNARD H SHULMAN MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERNARD H SHULMAN MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083743553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 HUEHL RD
Provider Second Line Business Mailing Address:
BLDG 8
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-2319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-770-6082
Provider Business Mailing Address Fax Number:
847-562-0202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9669 KENTON AVE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60076-1266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-679-8000
Provider Business Practice Location Address Fax Number:
847-679-8002
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERRIOS
Authorized Official First Name:
JANEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
847-770-6088

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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