MEDICARE: BRADLEY D WOOD 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	207P00000X	Emergency Medicine Physician	036-078212	IL

General Provider Information

NPI Number	:	1780650135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY D WOOD MD

Provider Business Mailing Address
First Line	:	2691 E 250 NORTH RD
Second Line	:
City	:	PANA
State	:	IL
Zip	:	62557-6659
Country	:	US
Telephone Number	:	217-562-3852
Fax Number	:

Provider Business Practice Location Address
First Line	:	2691 E 250 NORTH RD
Second Line	:
City	:	PANA
State	:	IL
Zip	:	62557-6659
Country	:	US
Telephone Number	:	217-562-3852
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	04/24/2013

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