Provider Demographics
NPI:1285328096
Name:STOKES, EDWARD AUSTIN
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:AUSTIN
Last Name:STOKES
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 1:1033 W LOYOLA AVE APT 604
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5216
Mailing Address - Country:US
Mailing Address - Phone:631-335-2620
Mailing Address - Fax:
Practice Address - Street 1:17 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4310
Practice Address - Country:US
Practice Address - Phone:131-266-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program