Healthcare Provider Details

I. General information

NPI: 1154569580
Provider Name (Legal Business Name): LILA DANA ELMAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W DUNDEE RD EAST ENTRANCE
WHEELING IL
60090-3936
US

IV. Provider business mailing address

1111 W DUNDEE RD EAST ENTRANCE
WHEELING IL
60090-3936
US

V. Phone/Fax

Practice location:
  • Phone: 224-676-0905
  • Fax: 224-676-0714
Mailing address:
  • Phone: 224-676-0905
  • Fax: 224-676-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036121890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: