Provider Demographics
NPI:1598762601
Name:HERSH, BRYAN LOUIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LOUIS
Last Name:HERSH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25 E SCHAUMBURG RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3548
Mailing Address - Country:US
Mailing Address - Phone:847-352-1473
Mailing Address - Fax:847-352-1479
Practice Address - Street 1:414 N ORLEANS ST STE 212
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4493
Practice Address - Country:US
Practice Address - Phone:312-923-1100
Practice Address - Fax:312-923-2356
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005021213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU85834Medicare UPIN
K46718Medicare PIN