Provider Demographics
NPI:1033470547
Name:EDGAR G. CHEDRAWY MD SC
Entity Type:Organization
Organization Name:EDGAR G. CHEDRAWY MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHEDRAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-590-1500
Mailing Address - Street 1:1655 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:203E
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3982
Mailing Address - Country:US
Mailing Address - Phone:847-590-1500
Mailing Address - Fax:847-590-1502
Practice Address - Street 1:1655 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:203E
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3982
Practice Address - Country:US
Practice Address - Phone:847-590-1500
Practice Address - Fax:847-590-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111934208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111934Medicaid