MEDICARE: DR. DAWN P BRADLY 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	125053496	IL

General Provider Information

NPI Number	:	1578729240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWN P BRADLY MD

Provider Business Mailing Address
First Line	:	1750 W HARRISON ST
Second Line	:	5TH FLOOR JELKE
City	:	CHICAGO
State	:	IL
Zip	:	60612-3825
Country	:	US
Telephone Number	:	312-942-6066
Fax Number	:	312-942-4228

Provider Business Practice Location Address
First Line	:	1750 W HARRISON ST
Second Line	:	5TH FLOOR JELKE
City	:	CHICAGO
State	:	IL
Zip	:	60612-3825
Country	:	US
Telephone Number	:	312-942-6066
Fax Number	:	312-942-4228

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

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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