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NPI Code Detail

MEDICARE: KRISTOPHER BRIDGEMAN PA

MEDICARE: KRISTOPHER BRIDGEMAN PA
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
1363A00000XPhysician Assistant085006497IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1085006497OTHERILIL PA LICENSE

General Provider Information

NPI Number : 1649779471
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTOPHER BRIDGEMAN PA
Provider Business Mailing Address
First Line : 951 ESSINGTON RD
Second Line :
City : JOLIET
State : IL
Zip : 60435-8439
Country : US
Telephone Number : 815-744-4551
Fax Number : 815-744-4756
Provider Business Practice Location Address
First Line : 951 ESSINGTON RD
Second Line :
City : JOLIET
State : IL
Zip : 60435-8439
Country : US
Telephone Number : 815-744-4551
Fax Number : 815-744-4756
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2018
Last Update Date : 11/03/2020

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Directions to “ KRISTOPHER BRIDGEMAN PA” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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