Provider Demographics
NPI:1568468015
Name:CARD, EDWIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:L
Last Name:CARD
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 1:515 E GRANT ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3368
Mailing Address - Country:US
Mailing Address - Phone:309-833-3706
Mailing Address - Fax:
Practice Address - Street 1:515 E GRANT ST
Practice Address - Street 2:SUITE 211
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3368
Practice Address - Country:US
Practice Address - Phone:309-833-3706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060998208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060998OtherSTATE LICENSE NUMBER
IL724860Medicare Oscar/Certification
IL036060998OtherSTATE LICENSE NUMBER
ILD15417Medicare UPIN