Provider Demographics
NPI:1093792806
Name:EDELSTEIN, STEVE R (MD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:R
Last Name:EDELSTEIN
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 1:660 N WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1659
Mailing Address - Country:US
Mailing Address - Phone:847-535-5917
Mailing Address - Fax:847-535-5801
Practice Address - Street 1:73 REMITTANCE DR
Practice Address - Street 2:SUITE 1951
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60675-1000
Practice Address - Country:US
Practice Address - Phone:847-535-5917
Practice Address - Fax:847-535-5801
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36096751207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36096751Medicaid