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General NPI Number Information
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NPI Number | 1922178391
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Entity Type | Individual
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Provider Name | EDMUND WALTER VIZINAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 6918 W ARCHER AVE 3 AND 4
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City | CHICAGO
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State | IL
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Zip | 60638-2337
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Country | US
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Telephone | 773-229-9965
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Fax | 773-229-9849
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Provider Business Mailing Address
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Address Line | 6918 W ARCHER AVE 3 AND 4
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City | CHICAGO
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State | IL
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Zip | 60638-2337
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Country | US
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Telephone | 773-229-9965
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Fax | 773-229-9849
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-159443
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License Number State | IL
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