MEDICARE: BRIDGECARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	IL
2	363A00000X	Physician Assistant	IL
3	363L00000X	Nurse Practitioner	IL
4	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	IL

General Provider Information

NPI Number	:	1033507249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGECARE, INC.

Provider Business Mailing Address
First Line	:	2250 E DEVON AVE
Second Line	:	SUITE 333
City	:	DES PLAINES
State	:	IL
Zip	:	60018-4511
Country	:	US
Telephone Number	:	224-803-2273
Fax Number	:	224-803-2274

Provider Business Practice Location Address
First Line	:	2250 E DEVON AVE
Second Line	:	SUITE 333
City	:	DES PLAINES
State	:	IL
Zip	:	60018-4511
Country	:	US
Telephone Number	:	224-803-2273
Fax Number	:	224-803-2274

Authorized Official
Title or Position	:	CEO
Name	:	HEMALI SHAH
Credential	:
Telephone Number	:	224-803-2273

Provider Enumeration Date	:	12/23/2014
Last Update Date	:	03/11/2015

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Directions to “BRIDGECARE, INC. ” Practice Location

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