Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 209.004416 | IL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 209.004416 | IL |
NPI | 1003075706 |
---|---|
Provider Name | Mr. Gerald M. Bedore |
First Address | Chicago, IL 60612-3748 |
Second Address | Chicago, IL 60612-3748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 06/06/2008 |