Provider Demographics
NPI:1073617254
Name:BERNARDI, PASQUALE G (MD)
Entity type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:G
Last Name:BERNARDI
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 1:10350 HALIGUS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9545
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:847-802-7200
Practice Address - Street 1:10350 HALIGUS RD STE 200
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9545
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:847-802-7200
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127258208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127258OtherSTATE LICENSE
IL962341043Medicare PIN
MD343811200Medicaid