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NPI Code Detail

MEDICARE: MEGHAN KATHLEEN EDMUNDSON M.D.

MEDICARE: MEGHAN KATHLEEN EDMUNDSON M.D.
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
12084P0800XPsychiatry Physician036141758IL
22084P0804XChild & Adolescent Psychiatry Physician036141758IL
3208000000XPediatrics Physician8436531UT

General Provider Information

NPI Number : 1225337496
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGHAN KATHLEEN EDMUNDSON M.D.
Provider Business Mailing Address
First Line : 3047 N LINCOLN AVE UNIT 400
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4274
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3047 N LINCOLN AVE UNIT 400
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4274
Country : US
Telephone Number : 773-505-1967
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2011
Last Update Date : 01/23/2019

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