MEDICARE: DR. EDWIN R PRIEST 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
1	207RH0003X	Hematology & Oncology Physician	036-074236	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588625875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN R PRIEST M.D.

Provider Business Mailing Address
First Line	:	800 BIESTERFIELD RD
Second Line	:	SUITE 210
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BIESTERFIELD RD
Second Line	:	SUITE 210
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3311
Country	:	US
Telephone Number	:	847-437-3312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	07/08/2007

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