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NPI Code Detail

MEDICARE: DR. BRIAN MEDERNACH BRIAN MEDERNACH

MEDICARE: DR. BRIAN MEDERNACH BRIAN MEDERNACH
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
1208000000XPediatrics Physician036.126376IL
2207RI0200XInfectious Disease Physician036.126376IL
3207R00000XInternal Medicine Physician036.126376IL

General Provider Information

NPI Number : 1801050539
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN MEDERNACH BRIAN MEDERNACH
Provider Business Mailing Address
First Line : 1S072 LUTHER AVE
Second Line :
City : LOMBARD
State : IL
Zip : 60148-4164
Country : US
Telephone Number : 630-247-8877
Fax Number :
Provider Business Practice Location Address
First Line : 1S072 LUTHER AVE
Second Line :
City : LOMBARD
State : IL
Zip : 60148-4164
Country : US
Telephone Number : 630-247-8877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2008
Last Update Date : 04/08/2026

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