Park, Edward J

Park, Edward J is an individual health care provider with primary practice located at 1401 S California Ave , Chicago IL 60608-1858. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is his primary health care specialty. Park, Edward J can be contacted via phone (773) 522-5120.

Contact Information

Primary practice address
1401 S California Ave Chicago IL 60608-1858
Phone: (773) 522-5120
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 036-108857 Illinois
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 036-108857 Illinois

Profile Details

NPI number 1891787008
LBN Legal business name Park, Edward J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2005
Last updated Dec 21st, 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 1891787008 NPPES
Illinois MEDICAID 036-108857-2

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