Provider Information for 1386023794
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STEPHEN EDWARDS
Sex: Male
NPI: 1386023794
Last Updated: 2015-05-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1386023794 | ||||||||
| Enumeration Date | 2015-05-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 908 N BROADWAY AVE APT 505 URBANA, IL 61801-1766 United States Phone: 217-974-0129 | Fax: | ||||||||
| Primary Practice Address | 1801 FOX DR CHAMPAIGN, IL 61820-7236 United States Phone: 217-398-8080 | Fax: | ||||||||
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