MEDICARE: EDWARD V GHISLANDI, M.D.PC

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	208D00000X	General Practice Physician

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	:	1861624421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD V GHISLANDI, M.D.PC

Provider Business Mailing Address
First Line	:	5641 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2742
Country	:	US
Telephone Number	:	773-282-2520
Fax Number	:	773-282-7970

Provider Business Practice Location Address
First Line	:	5641 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2742
Country	:	US
Telephone Number	:	773-282-2520
Fax Number	:	773-282-7970

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. MARIE BEAUCHAMP
Credential	:
Telephone Number	:	773-282-2520

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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