MR. GERALD M. BEDORE


Address: 835 S Wolcott Ave Rm E-144, Chicago, IL 60612-3748
Phone: 3129967420

MR. GERALD M. BEDORE (NPI# 1003075706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1003075706
Entity Type Individual
Full Name MR. GERALD M. BEDORE
Credential APN/CNP
Practice Address 835 S Wolcott Ave Rm E-144
Chicago
IL 60612-3748
Practice Telephone 3129967420
Practice Fax Number 3124138485
Mailing Telephone 3129967420
Mailing Fax Number 3124138485
Enumeration Date 2008-06-06
Last Update Date 2008-06-06
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LA2200X Nurse Practitioner
Specialization: Adult Health
209.004416 IL Physician Assistants & Advanced Practice Nursing Providers
N 363LG0600X Nurse Practitioner
Specialization: Gerontology
209.004416 IL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 835 S WOLCOTT AVE RM E-144
City CHICAGO
State IL
Zip Code 60612-3748

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Taxonomy Information

Taxonomy Code 363LA2200X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Adult Health

Taxonomy Definition

Definition to come...

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Competitor

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City CHICAGO
Zip Code 60612

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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