=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023275070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILLSDALE OB/GYN, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2008
-----------------------------------------------------
Last Update Date | 05/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1711 S HILLSDALE RD
-----------------------------------------------------
City | HILLSDALE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49242-8321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-437-5390
-----------------------------------------------------
Fax | 517-437-5382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1711 S HILLSDALE RD
-----------------------------------------------------
City | HILLSDALE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49242-8321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-437-5390
-----------------------------------------------------
Fax | 517-437-5382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALFRED K BEDIAKO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 517-437-5390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | 4301059194
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------