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NPI Code Detail

MEDICARE: EDMUND W VIZINAS, MD SC

MEDICARE: EDMUND W VIZINAS, MD SC
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
1207R00000XInternal Medicine Physician0IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
131600576OTHERILBCBS

General Provider Information

NPI Number : 1710102660
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDMUND W VIZINAS, MD SC
Provider Business Mailing Address
First Line : 6918 W ARCHER AVE
Second Line : SUITE 4
City : CHICAGO
State : IL
Zip : 60638-2337
Country : US
Telephone Number : 773-229-9965
Fax Number : 773-229-9849
Provider Business Practice Location Address
First Line : 6918 W ARCHER AVE
Second Line : SUITE 4
City : CHICAGO
State : IL
Zip : 60638-2337
Country : US
Telephone Number : 773-229-9965
Fax Number : 773-229-9849
Authorized Official
Title or Position : OWNER
Name : DR. EDMUND WALTER VIZINAS
Credential : M.D.
Telephone Number : 773-229-9965
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/21/2022

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