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General NPI Number Information
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NPI Number | 1013995679
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Entity Type | Individual
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Provider Name | EDWARD JOHN KEUER MD
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 1S 224 SUMMIT AVE SUITE 106
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181
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Country | US
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Telephone | 630-953-1190
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Fax | 630-953-1102
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Provider Business Mailing Address
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Address Line | 753 S WASHINGTON ST SUITE 106
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-5239
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Country | US
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Telephone | 630-953-1190
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Fax | 630-953-1102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036052394
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | F1094
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License Number State | TX
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