Healthcare Provider Details

I. General information

NPI: 1255399127
Provider Name (Legal Business Name): DEAN A ELIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 456
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1725 W HARRISON ST SUITE 456
CHICAGO IL
60612-3841
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-4270
  • Fax: 312-563-4280
Mailing address:
  • Phone: 312-563-4270
  • Fax: 312-563-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36059102
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: