Healthcare Provider Details

I. General information

NPI: 1528718715
Provider Name (Legal Business Name): SOPHIA ANTONIA BIDNY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

IV. Provider business mailing address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-2800
  • Fax: 312-227-9551
Mailing address:
  • Phone: 312-227-2800
  • Fax: 312-227-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.079619
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: