Provider Demographics
NPI:1952579054
Name:EDEN AURELIO MD SC
Entity Type:Organization
Organization Name:EDEN AURELIO MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:AURELIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-755-4548
Mailing Address - Street 1:301 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-2028
Mailing Address - Country:US
Mailing Address - Phone:309-755-4548
Mailing Address - Fax:309-755-4774
Practice Address - Street 1:301 17TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-2028
Practice Address - Country:US
Practice Address - Phone:309-755-4548
Practice Address - Fax:309-755-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36066418Medicaid
08105516OtherBCBS OF IL
C46240Medicare UPIN
IL36066418Medicaid