Healthcare Provider Details

I. General information

NPI: 1326159104
Provider Name (Legal Business Name): EDWIN BAUTISTA PASCUAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E WOODFIELD RD STE 745
SCHAUMBURG IL
60173-5132
US

IV. Provider business mailing address

1331 W HORSESHOE CT
ADDISON IL
60101-3146
US

V. Phone/Fax

Practice location:
  • Phone: 773-524-9811
  • Fax:
Mailing address:
  • Phone: 773-524-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036067770
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036067770
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: