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General NPI Number Information
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NPI Number | 1659538270
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Entity Type | Organization
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Legal Business Name | EDWARD J FESCO MD SC
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 206 MARQUETTE ST ROOM 206
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City | LASALLE
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State | IL
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Zip | 61301
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Country | US
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Telephone | 815-223-3616
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Fax | 815-223-0550
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Provider Business Mailing Address
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Address Line | 206 MARQUETTE ST ROOM 218
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City | LASALLE
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State | IL
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Zip | 61301
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Country | US
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Telephone | 815-223-3616
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Fax | 815-223-0550
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Authorized Official
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Title or Position | SOLO PRACTIONER
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Name | EDWARD JOHN FESCO
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Credential | MD
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Telephone | 815-223-3616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036034820
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License Number State | IL
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