MEDICARE: MISS BRIDGET ANN DINE

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	363A00000X	Physician Assistant	085011723	IL

General Provider Information

NPI Number	:	1356224570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRIDGET ANN DINE

Provider Business Mailing Address
First Line	:	12255 S 80TH AVE STE 204
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1284
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12255 S 80TH AVE STE 204
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1284
Country	:	US
Telephone Number	:	708-923-4400
Fax Number	:	708-923-4295

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

Provider Enumeration Date	:	07/26/2025
Last Update Date	:	01/06/2026

Similar Medicare Providers

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12255 S 80TH AVE STE 202
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1245422666 — LISA PUDUSSERI DO
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1194036632 — DR. ROBERT MAXSON M.D.
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Practice Location Address:

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1124446976 — KRISTINA QUINN DEGESYS M.D.
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Directions to “ MISS BRIDGET ANN DINE ” Practice Location

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