Provider Demographics
NPI:1144207416
Name:BERNFIELD, JEFFREY B (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:BERNFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 METTAWA LANE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3551
Mailing Address - Country:US
Mailing Address - Phone:847-374-8100
Mailing Address - Fax:847-374-8125
Practice Address - Street 1:2101 WAUKEGAN RD
Practice Address - Street 2:5 METTAWA LANE
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3551
Practice Address - Country:US
Practice Address - Phone:847-374-8100
Practice Address - Fax:847-374-8125
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360753372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00174158OtherRAILROAD MEDICARE
IL036075337Medicaid
ILP00174158OtherRAILROAD MEDICARE
ILE43648Medicare UPIN
ILL89897Medicare PIN