Provider Demographics
NPI:1326075854
Name:BERNAS, ELIZA F (MD)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:F
Last Name:BERNAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1749 PORTSMITH CT
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-7412
Mailing Address - Country:US
Mailing Address - Phone:630-377-7900
Mailing Address - Fax:630-377-8007
Practice Address - Street 1:1 TIFFANY PT
Practice Address - Street 2:SUITE 105
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2936
Practice Address - Country:US
Practice Address - Phone:630-980-1400
Practice Address - Fax:630-980-1441
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036088229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0222075OtherBLUE CROSS GROUP NUMBER
IL363149833OtherTAX IDENTIFICATION NUMBER
IL036088229Medicaid
IL3631498336019001OtherCDPG HFS PAYEE ID
ILF95466Medicare UPIN
IL0222075OtherBLUE CROSS GROUP NUMBER
IL036088229Medicaid