Portia Bonebrake is a Psychiatry in Chicago, Illinois. Portia Bonebrake practices all healthcare services and medical treatments related to Psychiatry. The NPI Number for Portia Bonebrake is 1073673760. The last update date is 2008-10-28.
Portia Bonebrake's current location address is 2542 W North Ave, Chicago, Illinois. You can contact this provider via phone number 7733657277 and fax number 7733653091. The mailing address for Portia Bonebrake is 2542 W North Ave, Chicago, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Portia Bonebrake |
|---|---|
| Address | 2542 W North Ave, Chicago, Illinois |
| Phone Number | 7733657277 |
| Fax Number | 7733653091 |
| Sole Proprietor | Y |
| Credentials | M.D. |
NPI Number Detail
| NPI Number | 1073673760 |
|---|---|
| Provider Enumeration Date | 2006-12-11 |
| Last Updated Date | 2008-10-28 |
Provider Mailing Address Detail
| Address | 2542 W North Ave |
|---|---|
| City | Chicago |
| State | Illinois (IL) |
| Post Code | 606475216 |
| Phone Number | 7733657277 |
| Fax Number | 7733653091 |
Provider's Primary Taxonomy Detail
| Speciality | Psychiatry |
|---|---|
| Taxonomy | 2084P0800X |
| Licence No | 036-112602 |
|
Definition: A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 036-112602 | IL | STATE LICENSE NUMBER | |
| 36112602 | BLUE SHIELD | ||
| 36112602 | IL | -- |
Post Comment/ Review Below
What is the Portia Bonebrake's unique identification number?
The Portia Bonebrake has been assigned the NPI (National Provider Identifier) Number 1073673760 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Can you provide the Portia Bonebrake's physical address?
The Portia Bonebrake is physically located at 2542 W North Ave, in the city of Chicago, IL, with the postal code 606475216.
What is Portia Bonebrake's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Portia Bonebrake is Psychiatry, and the corresponding taxonomy classification code for this specialized field is 2084P0800X.
On what date did the Portia Bonebrake receive its 1073673760 assignment from the Centers for Medicare & Medicaid Services?
The Portia Bonebrake was assigned its 1073673760 by the Centers for Medicare & Medicaid Services on 2006-12-11.
As of what date were the details related to Portia Bonebrake most recently updated or revised?
The information pertaining to Portia Bonebrake, including its address, specialty, and other relevant details, was last updated or revised on 2008-10-28.
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