Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036121348 | IL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036121348 | IL |
NPI | 1457590457 |
---|---|
Provider Name | Dr. Sarkis Michael Bedikian |
First Address | Palos Hills, IL 60465-1971 |
Second Address | Palos Hills, IL 60465-1971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2009 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036121348 | (05) | IL |
215958120 | MEDICARE PTAN (01) | IL |
F400202371 | MEDICARE PTAN (01) | IL |
F400202372 | MEDICARE PTAN (01) | IL |