Provider Demographics
NPI:1255301313
Name:SAKS, BERNIE JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNIE
Middle Name:JOEL
Last Name:SAKS
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 1:615 VALLEY VIEW DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6150
Mailing Address - Country:US
Mailing Address - Phone:309-762-1072
Mailing Address - Fax:309-762-1094
Practice Address - Street 1:615 VALLEY VIEW DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6150
Practice Address - Country:US
Practice Address - Phone:309-762-1072
Practice Address - Fax:309-762-1094
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3360549292085R0202X
IA313692085R0202X
WI393640202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA50088Medicare UPIN
IA32664OtherWELLMARK MAQUOKETA LOCATI
IA04726OtherWELLMARK OFFICE LOCATION
IAA50088Medicare UPIN
IA1139121Medicaid
IA0139121Medicaid
IA54511OtherWELLMARK FINLEY LOCATION
IA2139121Medicaid
IA32664Medicare ID - Type UnspecifiedMAQUOKETA
IA54511Medicare ID - Type UnspecifiedDUBUQUE SITES
WI32260400Medicaid