Provider Demographics
NPI:1750351789
Name:BIELEFELD, DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:BIELEFELD
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 1:18210 LA GRANGE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18210 LA GRANGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-7722
Practice Address - Country:US
Practice Address - Phone:708-478-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-081544207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00336995OtherRAILROAD MEDICARE
E92456Medicare UPIN
ILK20355Medicare PIN
ILP00336995OtherRAILROAD MEDICARE