Provider Demographics
NPI:1861662140
Name:BERMUDEZ, RUBEN (PA)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 E RAND RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4366
Mailing Address - Country:US
Mailing Address - Phone:224-735-3522
Mailing Address - Fax:224-735-3523
Practice Address - Street 1:1925 E RAND RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:224-735-3522
Practice Address - Fax:224-735-3523
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001367363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085001367OtherPHYSICIAN ASSISTANT
IL085001367OtherPHYSICIAN ASSISTANT