Provider Demographics
NPI:1356503221
Name:FAMILY MEDICAL
Entity Type:Organization
Organization Name:FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-392-7400
Mailing Address - Street 1:3295 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:#102
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1565
Mailing Address - Country:US
Mailing Address - Phone:847-392-7400
Mailing Address - Fax:847-392-0036
Practice Address - Street 1:3295 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:#102
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1565
Practice Address - Country:US
Practice Address - Phone:847-392-7400
Practice Address - Fax:847-392-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI 68092Medicare UPIN