Provider Demographics
NPI:1922162551
Name:BIENIARZ, ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:BIENIARZ
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 1:820 S. WOOD ST.
Mailing Address - Street 2:M/C 808
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7313
Mailing Address - Country:US
Mailing Address - Phone:312-996-7300
Mailing Address - Fax:312-996-4238
Practice Address - Street 1:820 S. WOOD ST.
Practice Address - Street 2:M/C 808
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7313
Practice Address - Country:US
Practice Address - Phone:312-996-7300
Practice Address - Fax:312-996-4238
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-055479207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055479Medicaid
ILK33888Medicare PIN
IL256510Medicare PIN
B56349Medicare UPIN