Provider Demographics
NPI:1568656445
Name:RANCHERO, BERNIE (MD)
Entity Type:Individual
Prefix:
First Name:BERNIE
Middle Name:
Last Name:RANCHERO
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 1:5 E CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:IL
Mailing Address - Zip Code:62411-1271
Mailing Address - Country:US
Mailing Address - Phone:618-483-6131
Mailing Address - Fax:
Practice Address - Street 1:5 E CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:IL
Practice Address - Zip Code:62411-1271
Practice Address - Country:US
Practice Address - Phone:618-483-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010025569207Q00000X
IL125053683390200000X
IL036123915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program