Healthcare Provider Details

I. General information

NPI: 1699981886
Provider Name (Legal Business Name): EDGAR RIOS M.D., S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4152 W 26TH ST
CHICAGO IL
60623-4312
US

IV. Provider business mailing address

203 MIDWEST CLUB PKWY
OAK BROOK IL
60523-2508
US

V. Phone/Fax

Practice location:
  • Phone: 773-521-1100
  • Fax: 773-521-9032
Mailing address:
  • Phone: 773-521-1100
  • Fax: 773-521-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number036048072
License Number StateIL

VIII. Authorized Official

Name: RICARDO R RIOS
Title or Position: UROLOGY
Credential: MD
Phone: 773-521-1100