Healthcare Provider Details

I. General information

NPI: 1265625040
Provider Name (Legal Business Name): EDWARD J. KEUER MD, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S 224 SUMIIT AVE SUITE 106
OAKBROOK TERRACE IL
60181-3944
US

IV. Provider business mailing address

1 S 224 SUMMIT AVE SUITE 106
OAKBROOK TERRRACE IL
60181-3944
US

V. Phone/Fax

Practice location:
  • Phone: 630-953-1190
  • Fax: 630-953-1102
Mailing address:
  • Phone: 630-953-1190
  • Fax: 630-953-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: EDWARD J KEUER III
Title or Position: OFFICE ADMIN
Credential: M.D.
Phone: 630-953-1190