Healthcare Provider Details

I. General information

NPI: 1043906969
Provider Name (Legal Business Name): ELIZABETH PETELSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH GEEVARGHESE

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 N RICHMOND RD
MCHENRY IL
60051-5407
US

IV. Provider business mailing address

415 N PATTON AVE
ARLINGTON HEIGHTS IL
60005-1209
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.176851
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: