Provider Demographics
NPI:1508843285
Name:TENNER, EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:TENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1035 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1711
Mailing Address - Country:US
Mailing Address - Phone:847-251-9375
Mailing Address - Fax:847-674-8465
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:STE 430
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1458
Practice Address - Country:US
Practice Address - Phone:847-674-8400
Practice Address - Fax:847-674-8465
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036053038207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053038Medicaid
C39632Medicare UPIN