Healthcare Provider Details

I. General information

NPI: 1295001907
Provider Name (Legal Business Name): ELLEN THERESE PARKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLEN THERESE KLOCKER MD

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N YORK ST
ELMHURST IL
60126-2377
US

IV. Provider business mailing address

7005 NORTH AVE
OAK PARK IL
60302-1001
US

V. Phone/Fax

Practice location:
  • Phone: 708-327-7030
  • Fax: 630-833-8834
Mailing address:
  • Phone: 708-327-1410
  • Fax: 708-383-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036137516
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036137516
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: