1043430812 NPI number — MR. EDWIN DEWEES KYLE III PAC

Table of content: MR. EDWIN DEWEES KYLE III PAC (NPI 1043430812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043430812 NPI number — MR. EDWIN DEWEES KYLE III PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KYLE
Provider First Name:
EDWIN
Provider Middle Name:
DEWEES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
PAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043430812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3032 PARK PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-619-2189
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9600 GROSS POINT ROAD
Provider Second Line Business Practice Location Address:
RUSH NORTH SHORE MEDICAL CENTER DEPT OF SURGERY
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-933-6020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)