Individual ProviderNathan FedorsRadiologyAllopathic & Osteopathic PhysiciansPractice Address2160 S 1st Ave, Loyola University Medical Center, Dept. Of Radiology, Maywood, IL 60153-3328(708) 216-1084PECOS EnrollmentBased on the most recent information from CMS, provider Nathan Fedors is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 7 days ago.Profile DetailsProvider ID1699933366Provider TypeIndividualFull NameFedors, NathanCredentialM.D.GenderMaleSole ProprietorYesEnumeration Date5/29/2008Last Updated5/30/2012Contact InformationPractice LocationPractice Address2160 S 1st Ave, Loyola University Medical Center, Dept. Of Radiology, Maywood, IL 60153-3328Phone(708) 216-1084FaxUnlisted FaxMailing LocationMailing Address2160 S 1st Ave, Loyola University Medical Center, Dept. Of Radiology, Maywood, IL 60153-3328Phone(708) 216-1084FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicense036128494Illinois