Basic Information
| Provider Information | |||||||||
| NPI: | 1336147156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BESSONNY | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8135 N MILWAUKEE AVE | ||||||||
| Address2: | |||||||||
| City: | NILES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607142828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479678098 | ||||||||
| FaxNumber: | 8479678594 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 W HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | BARRINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600107509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473819600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/17/2006 | ||||||||
| NPIReactivationDate: | 03/24/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 036088043 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 01626522 | 01 | IL | BLUE SHIELD OF ILLINOIS | OTHER | 036088043 | 05 | IL | MEDICAID |