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425 Davis St Unit 519 Evanston IL 60201-4790 | |
| (847) 433-2290 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 425 Davis St Unit 519, Evanston, Illinois |
| Authorized Official Name and Position | Myron Bornstein (PRESIDENT) |
| Authorized Official Contact | 8474337001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1770 1st St Highland Park IL 60035-3200 Ph: (847) 433-2290 | 425 Davis St Unit 519 Evanston IL 60201-4790 Ph: (847) 433-2290 |
| NPI Number | 1326223934 |
|---|---|
| Provider Enumeration Date | 01/02/2008 |
| Last Update Date | 10/30/2020 |
| Certification Date | 10/30/2020 |
| Medicare PECOS PAC ID | 8729079488 |
|---|---|
| Medicare Enrollment ID | O20040520001307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326223934 | NPI | - | NPPES |
| 208695 | Other | IL | MEDICARE SC ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036-038938 (Illinois) | Primary |
| Provider Name | Myron P Bornstein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255461463 PECOS PAC ID: 7315938073 Enrollment ID: I20040520001370 |
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