Provider Demographics
NPI:1073622718
Name:HSI, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 E DEMPSTER STREET
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-296-3577
Mailing Address - Fax:847-296-8981
Practice Address - Street 1:2604 E DEMPSTER STREET
Practice Address - Street 2:SUITE 403
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-296-3577
Practice Address - Fax:847-296-8981
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 070984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL316 04254OtherBCBS
IL976380Medicare PIN
C38202Medicare UPIN