Egdcltd

Primary specialty

DentistTaxonomy code 122300000X

License

019020204 Issued in IL

Legal business name

EGDCLTD

Practice address

2451 W 79TH St
Chicago, IL 60652-1734

Phone

(312) 885-0562

NPI assigned

Jan 26, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Kadziela

Title

Dentist

Phone

(312) 885-0562

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485388800000",
    "number": "1649717752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 W 79TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606521734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 W 79TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606521734",
            "telephone_number": "312-885-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EGDCLTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-26",
        "last_updated": "2017-01-26",
        "status": "A",
        "authorized_official_last_name": "KADZIELA",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "312-885-0562",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019020204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019020204",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Michael Eganhouse, MD
• Mira Egbaria, D.D.S.
• Azelle Egbe
• Solomon Tabe Egbe Jr.
• Tyler Egbert
• Samantha Michelle Ege, MS, LPC
• Marilyn Egel, LCSW
• Daniel Eggeman
• John Fontaine Egger, M.D.
• Michael Eggerstedt, MD

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.