Provider Demographics
NPI:1164525275
Name:DUARTE, BERNARDO (MD)
Entity Type:Individual
Prefix:
First Name:BERNARDO
Middle Name:
Last Name:DUARTE
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:PO BOX 2143
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-8143
Mailing Address - Country:US
Mailing Address - Phone:630-472-1111
Mailing Address - Fax:630-472-1125
Practice Address - Street 1:1841 W. ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60101
Practice Address - Country:US
Practice Address - Phone:630-472-1111
Practice Address - Fax:773-564-5186
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047859208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2221777OtherBLUE CROSS BLUE SHIELD
IL036047859Medicaid
ILIL3554Medicare PIN
IL036047859Medicaid