| Doctor Name: | DR. MARK IRA BORNSTEIN |
| NPI Number: | 1518078351 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | 071-004534 |
| Business Practice Address: | 175 Olde Half Day Rd Suite 140-2 Lincolnshire, IL - 600693061 |
| Business Phone Number: | 8474718883 |
| Business Fax Number: | 7737512250 |
| Mailing Address: | 46 Cumberland Dr, LINCOLNSHIRE |
| State: | IL |
| Postal Code: | 60069 |
| Phone Number: | 8474718883 |
| Fax Number: | 7737512250 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 05/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071-004534 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |