Provider Demographics
NPI:1649228727
Name:BERNHARD, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BERNHARD
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 1:1300 WATERFORD DR
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5502
Mailing Address - Country:US
Mailing Address - Phone:630-851-1206
Mailing Address - Fax:630-820-9398
Practice Address - Street 1:1180 W WILSON ST
Practice Address - Street 2:STE E
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-7611
Practice Address - Country:US
Practice Address - Phone:630-879-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-068148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068148Medicaid
ILD15808Medicare UPIN
380970Medicare PIN