# EDEN HEALTH MEDICAL OF IL LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083297469
- **Authorized official:** DONALD WAYNE JENKINS MD (PRESIDENT)
- **Authorized official phone:** (917) 261-4414

## Contact information

- **Practice address:** 131 S DEARBORN ST, CHICAGO, IL 60603-5517
- **Practice address phone:** (917) 261-4414
- **Mailing address:** 77 GOODELL ST STE 510, BUFFALO, NY 14203-1258
- **Mailing address phone:** (917) 261-4414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 05/03/2021
- **Last updated:** 09/13/2024