Provider Demographics
NPI:1023094463
Name:BEATA S BEDNARSKA MD PC
Entity type:Organization
Organization Name:BEATA S BEDNARSKA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEATA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEDNARSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-763-7522
Mailing Address - Street 1:1215 PARK RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5005
Mailing Address - Country:US
Mailing Address - Phone:847-698-2669
Mailing Address - Fax:847-720-2669
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:STE 308, PROFESSIONAL RESURRECTION BLD
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-763-7522
Practice Address - Fax:773-763-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherCOMMERCIAL
207761Medicare ID - Type Unspecified
G38780Medicare UPIN