Provider Demographics
NPI:1306932751
Name:LAVOLL AND EDGER, S.C.
Entity type:Organization
Organization Name:LAVOLL AND EDGER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-209-1123
Mailing Address - Street 1:3122 N SHERIDAN RD APT B2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4936
Mailing Address - Country:US
Mailing Address - Phone:312-209-1123
Mailing Address - Fax:312-988-9215
Practice Address - Street 1:3122 N SHERIDAN RD APT B2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4936
Practice Address - Country:US
Practice Address - Phone:312-209-1123
Practice Address - Fax:312-988-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069216261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)