Healthcare Provider Details

I. General information

NPI: 1154380947
Provider Name (Legal Business Name): EDEN U PADILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS RED ROVER RECRUIT TRAINING CENTER
GREAT LAKES IL
60088
US

IV. Provider business mailing address

4409 LAINIE CIRCLE
GLENVIEW IL
60026-1226
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-4909
  • Fax:
Mailing address:
  • Phone: 847-688-4909
  • Fax: 847-688-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: