Healthcare Provider Details

I. General information

NPI: 1740793074
Provider Name (Legal Business Name): ELEMENTAL HEALTH LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14484 JOHN HUMPHREY DR
ORLAND PARK IL
60462-2638
US

IV. Provider business mailing address

14484 JOHN HUMPHREY DR
ORLAND PARK IL
60462-2638
US

V. Phone/Fax

Practice location:
  • Phone: 708-892-2900
  • Fax: 708-892-2909
Mailing address:
  • Phone: 708-892-2900
  • Fax: 708-892-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTINS A ADEOYE
Title or Position: CEO
Credential: MD
Phone: 708-892-2900