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NPI Code Detail

MEDICARE: SHELDON L EDELSON MD SC

MEDICARE: SHELDON L EDELSON MD SC
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
1207R00000XInternal Medicine PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10021608860OTHERILBLUECROSS/BLUESHIELD

General Provider Information

NPI Number : 1316029499
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHELDON L EDELSON MD SC
Provider Business Mailing Address
First Line : 4640 N MARINE DR
Second Line : A6200
City : CHICAGO
State : IL
Zip : 60640-5719
Country : US
Telephone Number : 773-334-8633
Fax Number : 773-334-8681
Provider Business Practice Location Address
First Line : 4640 N MARINE DR
Second Line : A6200
City : CHICAGO
State : IL
Zip : 60640-5719
Country : US
Telephone Number : 773-334-8633
Fax Number : 773-334-8681
Authorized Official
Title or Position : PRESIDENT
Name : DR. SHELDON EDELSON
Credential : M.D.
Telephone Number : 773-334-8633
Provider Enumeration Date : 10/19/2006
Last Update Date : 09/25/2007

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Directions to “SHELDON L EDELSON MD SC ” Practice Location

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