Provider Demographics
NPI:1639458128
Name:EDGE, ADRIENNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:M
Last Name:EDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2971 W ALGONQUIN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9406
Mailing Address - Country:US
Mailing Address - Phone:847-854-5490
Mailing Address - Fax:847-854-8257
Practice Address - Street 1:2971 W ALGONQUIN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9406
Practice Address - Country:US
Practice Address - Phone:847-854-5490
Practice Address - Fax:847-854-8257
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036101735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics