Provider Demographics
NPI:1548564537
Name:MARC D. BEAR, M.D., LLC
Entity Type:Organization
Organization Name:MARC D. BEAR, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-458-4671
Mailing Address - Street 1:2027 COLFAX ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2531
Mailing Address - Country:US
Mailing Address - Phone:773-458-4671
Mailing Address - Fax:847-328-3565
Practice Address - Street 1:1011 W WELLINGTON AVE
Practice Address - Street 2:#210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7187
Practice Address - Country:US
Practice Address - Phone:773-458-4671
Practice Address - Fax:847-328-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0959952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty