Healthcare Provider Details

I. General information

NPI: 1407267412
Provider Name (Legal Business Name): ELINA KAMAROFF D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W LAKE ST
MELROSE PARK IL
60160
US

IV. Provider business mailing address

8271 KATIE LN
FRANKFORT IL
60423-9212
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-3000
  • Fax:
Mailing address:
  • Phone: 708-870-3553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02007621A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.145709
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number036.145709
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: