Provider Demographics
NPI:1154792224
Name:HOWARD, E J
Entity type:Individual
Prefix:
First Name:E J
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18143 WATERWAY CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5222
Mailing Address - Country:US
Mailing Address - Phone:708-719-3120
Mailing Address - Fax:708-478-6296
Practice Address - Street 1:18143 WATERWAY CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5222
Practice Address - Country:US
Practice Address - Phone:708-719-3120
Practice Address - Fax:708-478-6296
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILH63021048322172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver