Provider Demographics
NPI:1255526927
Name:RONALD S BERNE MD SC
Entity type:Organization
Organization Name:RONALD S BERNE MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-237-6666
Mailing Address - Street 1:1733 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4305
Mailing Address - Country:US
Mailing Address - Phone:773-237-6666
Mailing Address - Fax:773-237-7350
Practice Address - Street 1:1733 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4305
Practice Address - Country:US
Practice Address - Phone:773-237-6666
Practice Address - Fax:773-237-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty