Individual
EDGAR E ARCHBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
6917 W CERMAK RD, BERWYN, IL 60408
(708) 749-8190
(708) 749-8190
Mailing address
6917 W CERMAK RD, BERWYN, IL 60402
(708) 749-8190
(708) 749-8190
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-069407
IL
207Q00000X
Family Medicine Physician
036069407
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01625394
BS
IL
05
—
036068407
—
IL
Enumeration date
05/17/2007
Last updated
12/22/2008
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