MEDICARE: BETHESDA MEDICARE SERVICES LTD

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1487990495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA MEDICARE SERVICES LTD

Provider Business Mailing Address
First Line	:	990 GRAND CANYON PKWY
Second Line	:	SUITE 418
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1739
Country	:	US
Telephone Number	:	331-472-8802
Fax Number	:	331-472-8803

Provider Business Practice Location Address
First Line	:	990 GRAND CANYON PKWY
Second Line	:	SUITE 418
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1737
Country	:	US
Telephone Number	:	331-472-8802
Fax Number	:	331-472-8803

Authorized Official
Title or Position	:	OWNER
Name	:	MEENA KRISHNA
Credential	:	MD
Telephone Number	:	331-472-8802

Provider Enumeration Date	:	12/19/2012
Last Update Date	:	10/02/2013

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