Provider Information for 1992934566
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ANDREA BERCOS
Sex: Female
NPI: 1992934566
Last Updated: 2009-07-05
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1992934566 | ||||||||
| Enumeration Date | 2009-07-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3411 N KENNICOTT AVE SUITE B ARLINGTON HEIGHTS, IL 60004-7813 United States Phone: 847-710-0089 | Fax:847-398-7808 | ||||||||
| Primary Practice Address | 3411 N KENNICOTT AVE SUITE B ARLINGTON HEIGHTS, IL 60004-7813 United States Phone: 847-710-0089 | Fax:847-398-7808 | ||||||||
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