Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 0101249785 | VA |
Y | 2086S0129X | Vascular Surgeon | 036139185 | IL |
N | 2086S0129X | Vascular Surgeon | 35-072723 | OH |
N | 2086S0129X | Vascular Surgeon | 38823 | KY |
NPI | 1124079249 |
---|---|
Provider Name | Dr. John D Edwards |
First Address | Arlington Heights, IL 60005-2355 |
Second Address | Arlington Heights, IL 60005-2355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000609662 | ANTHEM - NVA (01) | KY |
000023035Y | HUMANA - CTS (NVA) (01) | KY |
00533123 | MEDICARE KY - CTS (NVA) (01) | KY |
103475 | SIHO - NVA (01) | KY |
200164020 | (05) | IN |
2040375 | (05) | OH |
3709852000 | PASSPORT ADVTG - NVA (01) | KY |
50011792 | PASSPORT - NVA (01) | KY |
6286669 | CIGNA - NVA (01) | KY |
64960628 | (05) | KY |
E57975 | (02) | KY |
P00201740 | RR MEDICARE (01) | OH |
P00733104 | RR MCR-KY (NVA) (01) | KY |