Provider Demographics
NPI:1801915947
Name:BABIGUMIRA, EDWARD (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BABIGUMIRA
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 1:600 N NORTH CT
Mailing Address - Street 2:200
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8155
Mailing Address - Country:US
Mailing Address - Phone:847-496-5419
Mailing Address - Fax:847-496-7606
Practice Address - Street 1:600 N NORTH CT
Practice Address - Street 2:200
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8155
Practice Address - Country:US
Practice Address - Phone:847-496-5419
Practice Address - Fax:847-496-7606
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1323342081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036132334Medicaid