Provider Demographics
NPI:1124079249
Name:EDWARDS, JOHN D (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W CENTRAL RD STE 5000
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2355
Mailing Address - Country:US
Mailing Address - Phone:847-618-3800
Mailing Address - Fax:847-618-3809
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:SUITE 5000
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-618-3800
Practice Address - Fax:847-618-3809
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012497852086S0129X
OH35-0727232086S0129X
KY388232086S0129X
IL0361391852086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3709852000OtherPASSPORT ADVTG - NVA
KY64960628Medicaid
KY103475OtherSIHO - NVA
KY6286669OtherCIGNA - NVA
KY000000609662OtherANTHEM - NVA
IN200164020Medicaid
OH2040375Medicaid
KY50011792OtherPASSPORT - NVA
OHP00201740OtherRR MEDICARE
KYP00733104OtherRR MCR-KY (NVA)
KY000023035YOtherHUMANA - CTS (NVA)
KY00533123OtherMEDICARE KY - CTS (NVA)
KY0955301Medicare PIN
KY64960628Medicaid
KYP00733104OtherRR MCR-KY (NVA)
KY103475OtherSIHO - NVA