Provider Demographics
NPI:1336907021
Name:AMBER BARD MD LLC
Entity Type:Organization
Organization Name:AMBER BARD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-994-4488
Mailing Address - Street 1:11 DOUGLAS AVE
Mailing Address - Street 2:STE 251 #202
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 DOUGLAS AVE
Practice Address - Street 2:STE 251 #202
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120
Practice Address - Country:US
Practice Address - Phone:269-339-8831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty