Healthcare Provider Details

I. General information

NPI: 1053738187
Provider Name (Legal Business Name): ELI LOUIS BADER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 W OGDEN AVE
CHICAGO IL
60608-1647
US

IV. Provider business mailing address

1501 S CALIFORNIA AVE
CHICAGO IL
60608-1732
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-5840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number036.148913
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number282797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: