Healthcare Provider Details

I. General information

NPI: 1295910164
Provider Name (Legal Business Name): EDWARD PICKERING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W HARRISON ST FL 6
CHICAGO IL
60607-3106
US

IV. Provider business mailing address

1520 W HARRISON ST FL 6
CHICAGO IL
60607-3106
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6744
  • Fax:
Mailing address:
  • Phone: 312-942-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD71265
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036163867
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: