Provider Demographics
NPI:1497070940
Name:BADAL, EDWARD BADAL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BADAL
Last Name:BADAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:
Practice Address - Street 1:731 S IL ROUTE 21
Practice Address - Street 2:SUITE 130
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3813
Practice Address - Country:US
Practice Address - Phone:847-566-3337
Practice Address - Fax:847-816-3166
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036130633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130633Medicaid