Healthcare Provider Details

I. General information

NPI: 1194701128
Provider Name (Legal Business Name): EDMUND LIGMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR LL 1400
BLOOMINGTON IL
61701-3534
US

IV. Provider business mailing address

1505 EASTLAND DR LL 1400
BLOOMINGTON IL
61701-3534
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-4700
  • Fax: 309-665-0575
Mailing address:
  • Phone: 309-663-4700
  • Fax: 309-665-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036059597
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: