Healthcare Provider Details

I. General information

NPI: 1386207504
Provider Name (Legal Business Name): SAMUEL ELBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 E OGDEN AVE STOP 109
NAPERVILLE IL
60563-1631
US

IV. Provider business mailing address

PO BOX 552
LISLE IL
60532-0552
US

V. Phone/Fax

Practice location:
  • Phone: 630-984-9480
  • Fax: 630-984-9481
Mailing address:
  • Phone: 630-984-9480
  • Fax: 630-984-9481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036158949
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: