Healthcare Provider Details

I. General information

NPI: 1346696952
Provider Name (Legal Business Name): SORAB BEDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W BROSS AVE
CHICAGO IL
60608-5168
US

IV. Provider business mailing address

2400 W BROSS AVE
CHICAGO IL
60608-5168
US

V. Phone/Fax

Practice location:
  • Phone: 708-205-8288
  • Fax:
Mailing address:
  • Phone: 708-205-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049.320537
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056005274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: