Provider Demographics
NPI:1982688842
Name:BEDI, SABEEHA S (MD)
Entity Type:Individual
Prefix:
First Name:SABEEHA
Middle Name:S
Last Name:BEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3263 EATON RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6830
Mailing Address - Country:US
Mailing Address - Phone:920-433-3456
Mailing Address - Fax:
Practice Address - Street 1:3263 EATON ROAD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311
Practice Address - Country:US
Practice Address - Phone:920-433-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICE0993OtherRAILROAD MEDICARE GROUP
WV39785OtherLICENSE NUMBER
WICE0993OtherRAILROAD MEDICARE GROUP
G69164Medicare UPIN
WI080183881Medicare Oscar/Certification
WI000002Medicare Oscar/Certification
WI000046Medicare Oscar/Certification
WI000080Medicare Oscar/Certification