Provider Demographics
NPI:1467977751
Name:DEHGHAN-BERNABE, LLC
Entity Type:Organization
Organization Name:DEHGHAN-BERNABE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHGHAN-BERNABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-772-7130
Mailing Address - Street 1:2953 N DAMEN AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-8237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 WAUKEGAN RD STE 213
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2165
Practice Address - Country:US
Practice Address - Phone:847-998-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty