Provider Demographics
NPI:1225419617
Name:BENDICH, ILYA (MD)
Entity type:Individual
Prefix:DR
First Name:ILYA
Middle Name:
Last Name:BENDICH
Suffix:
Gender:
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-514-3500
Mailing Address - Fax:314-878-7678
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DEPT ORTHOPAEDIC SURGERY, STE 6A/6B/12A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-514-3500
Practice Address - Fax:314-878-7678
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021033713207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200103027Medicaid