1265625040 NPI number — EDWARD J. KEUER MD, LTD

Table of content: (NPI 1265625040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265625040 NPI number — EDWARD J. KEUER MD, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD J. KEUER MD, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1265625040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 S 224 SUMMIT AVE
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
OAKBROOK TERRRACE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-3944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-953-1190
Provider Business Mailing Address Fax Number:
630-953-1102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 S 224 SUMIIT AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
OAKBROOK TERRACE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60181-3944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-953-1190
Provider Business Practice Location Address Fax Number:
630-953-1102
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KEUER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE ADMIN
Authorized Official Telephone Number:
630-953-1190

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , 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)

  • Identifier: 1013995679 . This is a "EDWARD J. KEUER M.D. PROVIDER NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1356423651 . This is a "VIRGINIA T. ALLEN M.D. NPI NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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