Organization
EDNA RICHARD M D
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDNA L RICHARD M.D. (PRESIDENT / OWNER)
(312) 567-6691
Entity
Organization
Contact information
Practice address
2525 S MICHIGAN AVE, B390, CHICAGO, IL 60616-2333
(312) 567-6691
(312) 328-7895
Mailing address
777 OAKMONT LN, SUITE 1600, WESTMONT, IL 60559-5511
(630) 789-2550
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160083333
BCBS PROVIDER ID
IL
Enumeration date
05/10/2007
Last updated
01/30/2008
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