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General NPI Number Information
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NPI Number | 1699981886
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Entity Type | Organization
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Legal Business Name | EDGAR RIOS M.D., S.C
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 4152 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4312
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Country | US
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Telephone | 773-521-1100
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Fax | 773-521-9032
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Provider Business Mailing Address
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Address Line | 203 MIDWEST CLUB PKWY
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City | OAK BROOK
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State | IL
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Zip | 60523-2508
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Country | US
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Telephone | 773-521-1100
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Fax | 773-521-9032
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Authorized Official
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Title or Position | UROLOGY
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Name | RICARDO R RIOS
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Credential | MD
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Telephone | 773-521-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036048072
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License Number State | IL
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