Provider Demographics
NPI:1821193657
Name:HANDLER, BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:HANDLER
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 1:3800 N. LAKE SHORE DR.
Mailing Address - Street 2:#3E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3313
Mailing Address - Country:US
Mailing Address - Phone:773-935-1093
Mailing Address - Fax:773-935-1093
Practice Address - Street 1:3800 N. LAKE SHORE DR.
Practice Address - Street 2:#3E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3313
Practice Address - Country:US
Practice Address - Phone:773-935-1093
Practice Address - Fax:773-935-1093
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILB53368Medicare UPIN