Individual
DR. MITCHELL HARRIS BERSHADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
6931 NORTH AVE, OAK PARK, IL 60302-1053
(708) 763-0580
Mailing address
6931 NORTH AVE, OAK PARK, IL 60302-1053
(708) 763-0580
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
05005847A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000524384
BLUE CROSS / BLUE SHIELD
IN
01
—
000000533922
BLUE CROSS / BLUE SHIELD
IN
01
—
05005847A
STATE LICENSE
IN
05
—
200868480
—
IN
Enumeration date
07/12/2007
Last updated
10/31/2016
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