MEDICARE: BOHDAN FEDIRKO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	036098499	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033163563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOHDAN FEDIRKO MD

Provider Business Mailing Address
First Line	:	PO BOX 388309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-8309
Country	:	US
Telephone Number	:	773-585-7505
Fax Number	:	773-585-7507

Provider Business Practice Location Address
First Line	:	5255 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4915
Country	:	US
Telephone Number	:	773-585-7505
Fax Number	:	773-585-7507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	12/20/2016

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