Healthcare Provider Details

I. General information

NPI: 1912072497
Provider Name (Legal Business Name): ELIZABETH M FAULCONER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 N LAKEVIEW AVE APT 3408
CHICAGO IL
60614-1827
US

IV. Provider business mailing address

2626 N LAKEVIEW AVE APT 3408
CHICAGO IL
60614-1827
US

V. Phone/Fax

Practice location:
  • Phone: 847-864-1271
  • Fax: 773-692-7413
Mailing address:
  • Phone: 847-864-1271
  • Fax: 773-692-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036065141
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: