Healthcare Provider Details

I. General information

NPI: 1407887631
Provider Name (Legal Business Name): DINA MICHAEL ELARAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GALTER PAVILION 675 N. ST. CLAIR ST., STE 17-200
CHICAGO IL
60611
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 650
CHICAGO IL
60611-2929
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0900
  • Fax:
Mailing address:
  • Phone: 312-695-0641
  • Fax: 312-695-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036118704
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: