Provider Demographics
NPI:1326006610
Name:KEDZIERSKI, ALEXANDER SAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:SAUL
Last Name:KEDZIERSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-2031
Mailing Address - Country:US
Mailing Address - Phone:815-740-8100
Mailing Address - Fax:815-740-8101
Practice Address - Street 1:1201 EAGLE ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2031
Practice Address - Country:US
Practice Address - Phone:815-740-8100
Practice Address - Fax:815-740-8101
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36109679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04515143OtherBCBS
IL0727500001Medicare NSC
IL04515143OtherBCBS
IL390361020Medicare PIN