Provider Demographics
NPI:1588637953
Name:BRADSHAW, WILLIAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:BRADSHAW
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 1:1095 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0010
Mailing Address - Country:US
Mailing Address - Phone:773-477-4343
Mailing Address - Fax:773-477-5088
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-477-4343
Practice Address - Fax:773-477-5088
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078287208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078287Medicaid
IL060028585OtherRAILROAD MEDICARE
ILL19443Medicare PIN
IL060028585OtherRAILROAD MEDICARE
IL968650Medicare ID - Type Unspecified