Provider Demographics
NPI:1407835309
Name:BACH, BERNARD R (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:R
Last Name:BACH
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 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:#240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:# 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-243-4244
Practice Address - Fax:312-942-1517
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073187207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4028377OtherAETNA
IL1633878OtherBCBS
IL207073OtherMEDICARE PTAN LOCALITY 15
IL207067OtherMEDICARE PTAN LOCALITY 16
P00095130OtherRAILROAD MEDICARE
DA4902OtherRAILROAD MEDICARE PTAN
IL036073187Medicaid
IL036073187Medicaid
IL207067OtherMEDICARE PTAN LOCALITY 16
ILK01179Medicare PIN