Healthcare Provider Details

I. General information

NPI: 1548143191
Provider Name (Legal Business Name): EDEN ELON MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 FOX RIDGE DR
PLAINFIELD IL
60586-5565
US

IV. Provider business mailing address

6307 FOX RIDGE DR
PLAINFIELD IL
60586-5565
US

V. Phone/Fax

Practice location:
  • Phone: 708-250-8799
  • Fax:
Mailing address:
  • Phone: 708-250-8799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1841736642
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name: MRS. EBONY P BELLE-JOHNSON
Title or Position: ADVANCED PRACTICE NURSE PRACTITIONE
Credential: APN-BC FPA
Phone: 708-250-8799