Provider Demographics
NPI:1821098542
Name:BLEDSOE, SHELLY LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:LYNNE
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:808 MERRY LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1420
Mailing Address - Country:US
Mailing Address - Phone:630-586-9930
Mailing Address - Fax:630-530-9425
Practice Address - Street 1:2306 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3306
Practice Address - Country:US
Practice Address - Phone:773-731-0014
Practice Address - Fax:773-731-2034
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery