Individual
MAXWELL ETHAN EDMONDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3324 N CLIFTON AVE APT 2F, CHICAGO, IL 60657-2285
(401) 480-1194
Mailing address
3324 N CLIFTON AVE APT 2F, CHICAGO, IL 60657-2285
(401) 480-1194
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
IL
Other
Enumeration date
03/03/2015
Last updated
06/05/2022
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