Basic Information
| Provider Information | |||||||||
| NPI: | 1073618427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WITTELS | ||||||||
| FirstName: | BERNARD | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 W 22ND ST | ||||||||
| Address2: | SUITE 610 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605232006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305371720 | ||||||||
| FaxNumber: | 6305371724 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 RIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602023328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473166370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 07/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 036079949 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2011030637 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.