Organization
EDWARD J FESCO MD SC
Active
Parent organization
EDWARD J FESCO MD SC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EDWARD J FESCO MD SC
Authorized official
EDWARD JOHN FESCO MD (SOLO PRACTIONER)
(815) 223-3616
Entity
Organization
Contact information
Practice address
206 MARQUETTE ST, ROOM 206, LASALLE, IL 61301
(815) 223-3616
(815) 223-0550
Mailing address
206 MARQUETTE ST, ROOM 218, LASALLE, IL 61301
(815) 223-3616
(815) 223-0550
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036034820
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021757686
RR MED
IL
05
—
036034820
—
IL
01
—
05000151
BC & BS
IL
Enumeration date
05/21/2008
Last updated
05/21/2008
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