Provider Demographics
NPI:1245433671
Name:EDWARD PALOYAN, M.D., S.C.
Entity type:Organization
Organization Name:EDWARD PALOYAN, M.D., S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-655-0722
Mailing Address - Street 1:700 E OGDEN AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5569
Mailing Address - Country:US
Mailing Address - Phone:630-655-0722
Mailing Address - Fax:630-655-0728
Practice Address - Street 1:700 E OGDEN AVE
Practice Address - Street 2:STE 205
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5569
Practice Address - Country:US
Practice Address - Phone:630-655-0722
Practice Address - Fax:630-655-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036034801208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1538143557OtherNPI
IL1720076003OtherNPI
IL2210829OtherBLUE CROSS BLUE SHIELD
IL2201779OtherBLUE CROSS BLUE SHIELD IL
IL1124032784OtherNPI
IL1538143557OtherNPI
IL2201779OtherBLUE CROSS BLUE SHIELD IL
IL1124032784OtherNPI
ILE87211Medicare UPIN
ILD11047Medicare UPIN
544190Medicare ID - Type Unspecified