Provider Demographics
NPI:1598762601
Name:HERSH, BRYAN LOUIS (DPM)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LOUIS
Last Name:HERSH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 E SCHAUMBURG RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3548
Mailing Address - Country:US
Mailing Address - Phone:847-352-1473
Mailing Address - Fax:847-352-1479
Practice Address - Street 1:2101 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1836
Practice Address - Country:US
Practice Address - Phone:312-923-1100
Practice Address - Fax:312-923-2356
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005021213E00000X
IL016005021213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU85834Medicare UPIN
K46718Medicare PIN