Provider Demographics
NPI:1447212113
Name:BLAKEMAN, BRADFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:
Last Name:BLAKEMAN
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 1:2650 WARRENVILLE RD
Mailing Address - Street 2:STE 280
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-324-7915
Mailing Address - Fax:630-271-1813
Practice Address - Street 1:2650 WARRENVILLE RD STE 280
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2075
Practice Address - Country:US
Practice Address - Phone:630-324-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1048021208600000X, 208G00000X
IL036060663208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL92675OtherURBANA
ILL92675OtherROCKFORD
S26620OtherCOOK GROUP
ILL92675OtherMOLINE
344390OtherDUPAGE GROUP
IL36060663Medicaid
344390OtherDUPAGE GROUP
S26620OtherCOOK GROUP
ILL92675OtherMOLINE
ILL67317Medicare ID - Type Unspecified
ILL36036Medicare ID - Type Unspecified