MEDICARE: MR. BOGDAN DERYLO 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	207RN0300X	Nephrology Physician	22935	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447211966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BOGDAN DERYLO MD

Provider Business Mailing Address
First Line	:	210 S DESPLAINES ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-5500
Country	:	US
Telephone Number	:	312-654-2720
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5905
Country	:	US
Telephone Number	:	312-654-2700
Fax Number	:	866-954-5804

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

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	11/22/2024

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Directions to “ MR. BOGDAN DERYLO MD” Practice Location

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