Healthcare Provider Details

I. General information

NPI: 1912239963
Provider Name (Legal Business Name): DAVID ELJAIEK HIGGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

1255 S STATE ST UNIT 1706
CHICAGO IL
60605-1928
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone: 734-730-6714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125-056037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: