Healthcare Provider Details

I. General information

NPI: 1043129315
Provider Name (Legal Business Name): EDEM CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE STE 317
LITTLE ROCK AR
72205-5342
US

IV. Provider business mailing address

18 WOODFERN DR
LITTLE ROCK AR
72211-4476
US

V. Phone/Fax

Practice location:
  • Phone: 844-363-6638
  • Fax:
Mailing address:
  • Phone: 844-363-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DINESH EDEM
Title or Position: MD/OWNER
Credential:
Phone: 844-363-6638