Healthcare Provider Details

I. General information

NPI: 1477184562
Provider Name (Legal Business Name): CHICAGO NOSE AND SINUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 1425
CHICAGO IL
60611-4451
US

IV. Provider business mailing address

2549 WAUKEGAN RD STE 110
BANNOCKBURN IL
60015-1569
US

V. Phone/Fax

Practice location:
  • Phone: 312-480-1387
  • Fax:
Mailing address:
  • Phone: 708-689-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SIVA ELANGOVAN
Title or Position: MEMBER
Credential: MD
Phone: 708-689-4770