MEDICARE: BRADLEY DYNIEWSKI

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	A168005	CA

General Provider Information

NPI Number	:	1851779839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY DYNIEWSKI

Provider Business Mailing Address
First Line	:	329 PODRES LN
Second Line	:
City	:	CHATHAM
State	:	IL
Zip	:	62629-5003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1458 ESPLANADE STE 4
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-3309
Country	:	US
Telephone Number	:	530-332-4510
Fax Number	:

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

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	09/09/2020

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