Individual
EDWAED WELDON FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(773) 869-7488
Mailing address
1122 NEWBERRY AVE, LA GRANGE PARK, IL 60526-1249
(708) 415-0035
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
IL
Other
Enumeration date
04/02/2007
Last updated
07/08/2007
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