MEDICARE: DR. ELIZABETH ANN EKLUND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	36069112	IL

General Provider Information

NPI Number	:	1598861205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANN EKLUND MD

Provider Business Mailing Address
First Line	:	710 N FAIRBANKS CT
Second Line	:	OLSON PAVILION RM 8524
City	:	CHICAGO
State	:	IL
Zip	:	60611-3013
Country	:	US
Telephone Number	:	312-503-4625
Fax Number	:	312-908-5717

Provider Business Practice Location Address
First Line	:	710 N FAIRBANKS CT
Second Line	:	OLSON PAVILION RM 8524
City	:	CHICAGO
State	:	IL
Zip	:	60611-3013
Country	:	US
Telephone Number	:	312-503-4625
Fax Number	:	312-908-5717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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