Provider Demographics
NPI:1285632091
Name:ATKINS, EDWARD M (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:ATKINS
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 1:8135 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2828
Mailing Address - Country:US
Mailing Address - Phone:847-967-8098
Mailing Address - Fax:847-967-8594
Practice Address - Street 1:815 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3916
Practice Address - Country:US
Practice Address - Phone:847-869-8500
Practice Address - Fax:847-869-0028
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2007-10-04
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31600926OtherBLUE SHIELD OF ILLINOIS
ILK44299Medicare PIN
ILD15392Medicare UPIN