Basic Information
| Provider Information | |||||||||
| NPI: | 1972867976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASIEDU | ||||||||
| FirstName: | CANDACE | ||||||||
| MiddleName: | MERCY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ERIE CT | ||||||||
| Address2: | SUITE 6160 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087631490 | ||||||||
| FaxNumber: | 7087637232 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ERIE CT | ||||||||
| Address2: | SUITE 6160 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087631490 | ||||||||
| FaxNumber: | 7087637232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 06/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125061964 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.