Provider Demographics
NPI:1174653554
Name:BERNARD, HARRY N (DPM LTD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:N
Last Name:BERNARD
Suffix:
Gender:M
Credentials:DPM LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GREEN NUMBER 4 DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3336
Mailing Address - Country:US
Mailing Address - Phone:618-322-4579
Mailing Address - Fax:636-947-5498
Practice Address - Street 1:34 GREEN NUMBER 4 DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3336
Practice Address - Country:US
Practice Address - Phone:618-322-4579
Practice Address - Fax:636-947-5498
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002736213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016002736Medicaid
IL016002736Medicaid
IL209915Medicare PIN