Provider Demographics
NPI:1437322195
Name:BERRIDGE, BERNADINE ESPIRITU (MD)
Entity Type:Individual
Prefix:
First Name:BERNADINE
Middle Name:ESPIRITU
Last Name:BERRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BERNADINE
Other - Middle Name:
Other - Last Name:ESPIRITU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1817 S LOOMIS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3018
Mailing Address - Country:US
Mailing Address - Phone:312-666-6511
Mailing Address - Fax:312-666-1658
Practice Address - Street 1:1817 S LOOMIS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3018
Practice Address - Country:US
Practice Address - Phone:312-666-6511
Practice Address - Fax:312-666-1658
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128767208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
367830Medicare PIN