Individual
GEORGE B. BERANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2400 N ROCKTON AVE, ROCKFORD, IL 61103-3655
(815) 971-3333
Mailing address
2400 N ROCKTON AVE, ROCKFORD, IL 61103-3655
(815) 971-3333
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036074448
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036074448
—
IL
Enumeration date
11/07/2005
Last updated
01/11/2010
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