Doctor Name: | ANDRE EDWARDS |
NPI Number: | 1427205418 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 036122992 |
Business Practice Address: | 1200 Maple Rd Suite 3309 Joliet, IL - 604321439 |
Business Phone Number: | 8157239351 |
Business Fax Number: | 8157239823 |
Mailing Address: | 1200 Maple Rd, Suite 3309 JOLIET |
State: | IL |
Postal Code: | 604321439 |
Phone Number: | 8157239351 |
Fax Number: | 8157239823 |
NPI Enumeration Date: | 08/21/2008 |
NPI Last Update Date: | 07/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085B0100X |
License Number: | 036122992 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Body Imaging |
Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |