Provider Demographics
NPI:1174697163
Name:DRESNER, BRUCE L (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:L
Last Name:DRESNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 E HURON ST
Mailing Address - Street 2:STE 1101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2948
Mailing Address - Country:US
Mailing Address - Phone:312-337-6888
Mailing Address - Fax:312-943-9943
Practice Address - Street 1:150 E HURON ST
Practice Address - Street 2:STE 1101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2948
Practice Address - Country:US
Practice Address - Phone:312-337-6888
Practice Address - Fax:312-943-9943
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360458232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31600919Medicare ID - Type Unspecified