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NPI Code Detail

MEDICARE: DR. EDWARD J PARK M.D

MEDICARE: DR. EDWARD J PARK 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
12081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician036-108857IL
2208100000XPhysical Medicine & Rehabilitation Physician036-108857IL

Other Identifiers

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

General Provider Information

NPI Number : 1891787008
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD J PARK M.D
Provider Business Mailing Address
First Line : 1107 S MANNHEIM RD
Second Line :
City : WESTCHESTER
State : IL
Zip : 60154-2561
Country : US
Telephone Number : 708-786-2900
Fax Number :
Provider Business Practice Location Address
First Line : 1401 S CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1858
Country : US
Telephone Number : 773-522-5120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 12/21/2021

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