Healthcare Provider Details

I. General information

NPI: 1689566549
Provider Name (Legal Business Name): DANIEL FITZPATRICK BEDNAREK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PFINGSTEN RD
GLENVIEW IL
60026-1301
US

IV. Provider business mailing address

6037 N NASSAU AVE
CHICAGO IL
60631-2616
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-5800
  • Fax:
Mailing address:
  • Phone: 872-232-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085011399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: