Provider Demographics
NPI:1093800187
Name:BEDNAR, PATRICK F (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:F
Last Name:BEDNAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2703
Mailing Address - Country:US
Mailing Address - Phone:630-668-3210
Mailing Address - Fax:630-668-3505
Practice Address - Street 1:517 THORNHILL DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2703
Practice Address - Country:US
Practice Address - Phone:630-668-3210
Practice Address - Fax:630-668-3505
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054671Medicaid
777480001OtherMEDICARE PTAN
IL652150Medicare ID - Type Unspecified
IL036054671Medicaid