Provider Demographics
NPI:1477533297
Name:BEDIAKO, ALFRED K (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:K
Last Name:BEDIAKO
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 1:1711 S HILLSDALE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-8321
Mailing Address - Country:US
Mailing Address - Phone:517-437-5390
Mailing Address - Fax:517-437-5382
Practice Address - Street 1:1711 S HILLSDALE RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-8321
Practice Address - Country:US
Practice Address - Phone:517-437-5390
Practice Address - Fax:517-437-5382
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059194207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102829600Medicaid
MIF26757Medicare UPIN
MI102829600Medicaid