MEDICARE: DR. EDWARD A TRUDEAU 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	208100000X	Physical Medicine & Rehabilitation Physician	036062396	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	:	1841250339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD A TRUDEAU M.D.

Provider Business Mailing Address
First Line	:	319 E MADISON ST STE 2A
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62701-1035
Country	:	US
Telephone Number	:	217-788-3377
Fax Number	:	217-788-5505

Provider Business Practice Location Address
First Line	:	319 E MADISON ST STE 2A
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62701-1035
Country	:	US
Telephone Number	:	217-788-3377
Fax Number	:	217-788-5505

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/08/2025

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