MEDICARE: DR. EDWARD TENNER MD

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	207W00000X	Ophthalmology Physician	036053038	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508843285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD TENNER MD

Provider Business Mailing Address
First Line	:	1035 ELMWOOD AVE
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1711
Country	:	US
Telephone Number	:	847-251-9375
Fax Number	:	847-674-8465

Provider Business Practice Location Address
First Line	:	4905 OLD ORCHARD CTR
Second Line	:	STE 430
City	:	SKOKIE
State	:	IL
Zip	:	60077-1458
Country	:	US
Telephone Number	:	847-674-8400
Fax Number	:	847-674-8465

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	12/14/2011

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