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Organization
EDEN HEALTH MEDICAL OF IL LTD
Active
Organization
EDEN HEALTH MEDICAL OF IL LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE JENKINS MD (PRESIDENT)
(917) 261-4414
Entity
Organization
Contact information
Practice address
131 S DEARBORN ST, CHICAGO, IL 60603-5517
(917) 261-4414
Mailing address
77 GOODELL ST STE 510, BUFFALO, NY 14203-1258
(917) 261-4414
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NULL
101Y00000X
Counselor
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
Other
Enumeration date
05/03/2021
Last updated
09/13/2024
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