Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 36096751 | IL |
NPI | 1093792806 |
---|---|
Provider Name | Steve R Edelstein |
First Address | Lake Forest, IL 60045-1659 |
Second Address | Chicago, IL 60675-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 27/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36096751 | (05) | IL |