# EDGAR RIOS M.D., S.C

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

## Provider details

- **NPI number:** 1699981886
- **Authorized official:** RICARDO R RIOS MD (UROLOGY)
- **Authorized official phone:** (773) 521-1100

## Contact information

- **Practice address:** 4152 W 26TH ST, CHICAGO, IL 60623-4312
- **Practice address phone:** (773) 521-1100
- **Practice address fax:** (773) 521-9032
- **Mailing address:** 203 MIDWEST CLUB PKWY, OAK BROOK, IL 60523-2508
- **Mailing address phone:** (773) 521-1100
- **Mailing address fax:** (773) 521-9032

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 036048072 | IL | Yes |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 08/09/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0021608512 | BLUE CROSS NUMBER | IL |
| 05 | — | 036048072 | — | IL |
| 01 | — | 1881957405 | NPI | IL |