MEDICARE: DR. EBENEZER S. BEDIAKO MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	N1547	TX
2	208000000X	Pediatrics Physician	202914	LA
3	2080P0203X	Pediatric Critical Care Medicine Physician	202914	LA
4	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	202914	LA
5	208000000X	Pediatrics Physician	01063471A	IN

General Provider Information

NPI Number	:	1073731493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EBENEZER S. BEDIAKO MD

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	337-470-2605
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	4600 AMBASSADOR CAFFERY PKWY
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6902
Country	:	US
Telephone Number	:	337-470-5500
Fax Number	:	337-521-9166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	12/22/2025

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