Provider Demographics
NPI:1265625040
Name:EDWARD J. KEUER MD, LTD
Entity type:Organization
Organization Name:EDWARD J. KEUER MD, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEUER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:630-953-1190
Mailing Address - Street 1:1 S 224 SUMMIT AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OAKBROOK TERRRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3944
Mailing Address - Country:US
Mailing Address - Phone:630-953-1190
Mailing Address - Fax:630-953-1102
Practice Address - Street 1:1 S 224 SUMIIT AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3944
Practice Address - Country:US
Practice Address - Phone:630-953-1190
Practice Address - Fax:630-953-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013995679OtherEDWARD J. KEUER M.D. PROVIDER NPI
IL1356423651OtherVIRGINIA T. ALLEN M.D. NPI NUMBER
1013995679OtherEDWARD J. KEUER M.D. PROVIDER NPI
ILL81136Medicare PIN