Provider Demographics
NPI:1063462414
Name:BEDECKI, DANIEL J (MD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:BEDECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 S 6TH ST
Mailing Address - Street 2:STE 204
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807
Mailing Address - Country:US
Mailing Address - Phone:812-234-7128
Mailing Address - Fax:812-231-0104
Practice Address - Street 1:1024 S 6TH ST
Practice Address - Street 2:STE 204
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807
Practice Address - Country:US
Practice Address - Phone:812-234-7128
Practice Address - Fax:812-231-0104
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032307B208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000085360OtherBCBS PIN
B29157Medicare UPIN
520240Medicare ID - Type Unspecified