Provider Demographics
NPI:1366609323
Name:BEDNARZ, ANITA KINGA (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:KINGA
Last Name:BEDNARZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANETA
Other - Middle Name:KINGA
Other - Last Name:BEDNARZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:150 E WILLOW AVE STE 300
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5529
Practice Address - Country:US
Practice Address - Phone:630-510-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209753003Medicare PIN
IL036127230Medicaid
IL20020439OtherIL HEALTH CONNECT
IL1628468OtherBLUE CROSS BLUE SHIELD