Provider Demographics
NPI:1912951617
Name:VADIM EDELSTEIN MD LTD
Entity type:Organization
Organization Name:VADIM EDELSTEIN MD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-982-9988
Mailing Address - Street 1:4555 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3178
Mailing Address - Country:US
Mailing Address - Phone:847-982-9988
Mailing Address - Fax:847-982-9789
Practice Address - Street 1:4555 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3178
Practice Address - Country:US
Practice Address - Phone:847-982-9988
Practice Address - Fax:847-982-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID