Provider Demographics
NPI:1821043290
Name:BEAR, MARC D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:BEAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360959952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095995Medicaid
IL036095995Medicaid
IL036095995Medicaid