Individual
DR. EDMUND WALTER VIZINAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6918 W ARCHER AVE, 3 AND 4, CHICAGO, IL 60638-2337
(773) 229-9965
(773) 229-9849
Mailing address
6918 W ARCHER AVE, 3 AND 4, CHICAGO, IL 60638-2337
(773) 229-9965
(773) 229-9849
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-159443
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036059443
—
IL
01
—
1710102660
MEDICARE ID-TYPE UNSPECIFIED
IL
01
—
363326542
TRICARE
IL
01
—
CD7818
MEDICARE RR
IL
Enumeration date
11/09/2006
Last updated
06/23/2010
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