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General NPI Number Information
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NPI Number | 1891787008
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Entity Type | Individual
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Provider Name | EDWARD J PARK M.D
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 1401 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1858
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Country | US
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Telephone | 773-522-5120
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 S MANNHEIM RD
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City | WESTCHESTER
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State | IL
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Zip | 60154-2561
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Country | US
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Telephone | 708-786-2900
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Fax |
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036-108857
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036-108857
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License Number State | IL
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