Provider Demographics
NPI:1497792840
Name:EDM CONSULTANT SERVICES LTD
Entity Type:Organization
Organization Name:EDM CONSULTANT SERVICES LTD
Other - Org Name:RIM JOUBRAN
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUBRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-681-7695
Mailing Address - Street 1:675 W NORTH AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:708-681-7695
Mailing Address - Fax:708-345-7112
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:STE 104
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-681-7695
Practice Address - Fax:708-345-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36091925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3362078002OtherCIGNA
IL036091925Medicaid
IL21623287OtherBLUE CROSS BLUE SHIELD
IL545700Medicare ID - Type Unspecified
IL036091925Medicaid