Provider Demographics
NPI:1922075951
Name:BERESFORD, BRENDAN (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:BERESFORD
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 1:201 EAST OGDEN AVENUE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3655
Mailing Address - Country:US
Mailing Address - Phone:630-325-8893
Mailing Address - Fax:630-325-8939
Practice Address - Street 1:201 EAST OGDEN AVENUE
Practice Address - Street 2:SUITE 116
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2655
Practice Address - Country:US
Practice Address - Phone:630-325-8893
Practice Address - Fax:630-325-8939
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361060932084P0800X
IL036-1060932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106093Medicaid
ILE50470Medicare UPIN
IL368820Medicare PIN