Provider Demographics
NPI:1497836142
Name:BERMUDEZ, MAXIMO (MD)
Entity Type:Individual
Prefix:
First Name:MAXIMO
Middle Name:
Last Name:BERMUDEZ
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 1:2424 W PETERSON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4100
Mailing Address - Country:US
Mailing Address - Phone:312-526-2000
Mailing Address - Fax:312-526-2152
Practice Address - Street 1:2424 W PETERSON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4100
Practice Address - Country:US
Practice Address - Phone:773-761-0300
Practice Address - Fax:773-761-0009
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-090194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G71943Medicare UPIN