Archbold, Edgar E

Archbold, Edgar E is an individual health care provider with primary practice located at 6917 W Cermak Rd , Berwyn IL 60408. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Archbold, Edgar E can be contacted via phone (708) 749-8190.

Contact Information

Primary practice address
6917 W Cermak Rd Berwyn IL 60408
Phone: (708) 749-8190
Fax: (708) 749-8190
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036069407 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036-069407 Illinois

Profile Details

NPI number 1801003991
LBN Legal business name Archbold, Edgar E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2007
Last updated Dec 22nd, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801003991 NPPES
Illinois Other 01625394 BS
Illinois MEDICAID 036068407 BS

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