MEDICARE: DR. EDGAR M. ASEBEY 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	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1255359097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGAR M. ASEBEY M.D.

Provider Business Mailing Address
First Line	:	2001 S CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2486
Country	:	US
Telephone Number	:	773-254-6200
Fax Number	:	773-584-6149

Provider Business Practice Location Address
First Line	:	2001 S CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2486
Country	:	US
Telephone Number	:	773-254-6200
Fax Number	:	773-584-6149

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/09/2007

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