MEDICARE: DR. SHELLY LYNNE BLEDSOE M.D.

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	2086S0129X	Vascular Surgery Physician		IL

General Provider Information

NPI Number	:	1821098542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLY LYNNE BLEDSOE M.D.

Provider Business Mailing Address
First Line	:	808 MERRY LN
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1420
Country	:	US
Telephone Number	:	630-586-9930
Fax Number	:	630-530-9425

Provider Business Practice Location Address
First Line	:	2306 E 75TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-3306
Country	:	US
Telephone Number	:	773-731-0014
Fax Number	:	773-731-2034

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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