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General NPI Number Information
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NPI Number | 1831356690
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Entity Type | Organization
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Legal Business Name | PHYSICIANS EDGE PHO
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 750 PASQUINELLI DR SUITE 204
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City | WESTMONT
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State | IL
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Zip | 60559-5567
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Country | US
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Telephone | 708-783-7153
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Fax |
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Provider Business Mailing Address
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Address Line | 750 PASQUINELLI DR SUITE 204
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City | WESTMONT
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State | IL
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Zip | 60559-5567
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Country | US
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Telephone | 708-783-7153
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. KIM A ARMSTRONG
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Credential |
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Telephone | 708-783-7153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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