Individual
DR. EDWARD G DOLEZAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
280 A MEMORIAL COURT, CRYSTAL LAKE, IL 60014-6233
(815) 455-4222
(815) 455-5093
Mailing address
280 A MEMORIAL COURT, CRYSTAL LAKE, IL 60014-6233
(815) 455-4222
(815) 455-5093
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036-070162
IL
207W00000X
Ophthalmology Physician
Primary
036070162
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070162
—
IL
01
—
05625795
BCBS IL
IL
01
—
180038854
RAIL ROAD MEDICARE
—
Enumeration date
05/27/2006
Last updated
12/28/2021
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