=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922320902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD W. PIROK, M.D., PH.D., L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2010
-----------------------------------------------------
Last Update Date | 02/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 737 N MICHIGAN AVE SUITE 2240
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-2615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-291-4271
-----------------------------------------------------
Fax | 312-291-4271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 737 N MICHIGAN AVE SUITE 2240
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-2615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-291-4271
-----------------------------------------------------
Fax | 312-291-4271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EDWARD WARREN PIROK III
-----------------------------------------------------
Credential | M.D., PH.D.
-----------------------------------------------------
Telephone | 312-291-4271
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 036122641
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------