Dolezal, Edward G

Dolezal, Edward G is an sole proprietor health care provider with primary practice located at 280 A Memorial Court , Crystal Lake IL 60014-6233. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Dolezal, Edward G can be contacted via phone (815) 455-4222.

Contact Information

Primary practice address
280 A Memorial Court Crystal Lake IL 60014-6233
Phone: (815) 455-4222
Fax: (815) 455-5093
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 036-070162 Illinois
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 036070162 Illinois

Profile Details

NPI number 1821045782
LBN Legal business name Dolezal, Edward G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 27th, 2006
Last updated Dec 28th, 2021 - about 3 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 1821045782 NPPES
Illinois MEDICAID 036070162
Illinois Other 05625795
Illinois Other 180038854

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