Provider Demographics
NPI:1013995679
Name:KEUER, EDWARD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:KEUER
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 1:753 S WASHINGTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5239
Mailing Address - Country:US
Mailing Address - Phone:630-953-1190
Mailing Address - Fax:630-953-1102
Practice Address - Street 1:1S 224 SUMMIT AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-953-1190
Practice Address - Fax:630-953-1102
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052394207N00000X
TXF1094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1265625040OtherPRACTICE NPI
IL21608341OtherBCBS
IL36052394Medicaid
IL1265625040OtherPRACTICE NPI
IL21608341OtherBCBS
IL617051Medicare ID - Type Unspecified