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General NPI Number Information
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NPI Number | 1033959127
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Entity Type | Organization
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Legal Business Name | HEALING EDGE MEDICAL GROUP IL
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 1200 N ASHLAND AVE STE 500
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City | CHICAGO
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State | IL
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Zip | 60622-8327
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Country | US
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Telephone | 310-779-3224
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E HUNTINGTON DR STE 203
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City | ALHAMBRA
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State | CA
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Zip | 91801-1022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JEFFREY HALPERIN
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Credential |
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Telephone | 626-673-5605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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