Provider Demographics
NPI:1053304741
Name:NEWMAN, EDWARD M (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:3310 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1000
Practice Address - Country:US
Practice Address - Phone:630-897-6044
Practice Address - Fax:630-897-0180
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062491207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062491Medicaid
ILE11641Medicare UPIN