Individual
DR. EDWARD J PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1401 S CALIFORNIA AVE, CHICAGO, IL 60608-1858
(773) 522-5120
Mailing address
1107 S MANNHEIM RD, WESTCHESTER, IL 60154-2561
(708) 786-2900
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-108857
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
036-108857
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-108857-2
—
IL
Enumeration date
08/16/2005
Last updated
12/21/2021
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