Healthcare Provider Details

I. General information

NPI: 1851333025
Provider Name (Legal Business Name): ELIZA M PARKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 E OAK STREET, 6R
CHICAGO IL
60611-1231
US

IV. Provider business mailing address

34 E OAK STREET, 6R
CHICAGO IL
60611-1231
US

V. Phone/Fax

Practice location:
  • Phone: 312-915-0195
  • Fax: 800-858-1097
Mailing address:
  • Phone: 312-915-0195
  • Fax: 800-858-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036123192
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301086462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: