MEDICARE: HEALING EDGE MEDICAL GROUP IL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1033959127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING EDGE MEDICAL GROUP IL

Provider Business Mailing Address
First Line	:	100 E HUNTINGTON DR STE 203
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-1022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N ASHLAND AVE STE 500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-8327
Country	:	US
Telephone Number	:	310-779-3224
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JEFFREY HALPERIN
Credential	:
Telephone Number	:	626-673-5605

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	08/26/2024

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Directions to “HEALING EDGE MEDICAL GROUP IL ” Practice Location

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