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General NPI Number Information
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NPI Number | 1093869141
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Entity Type | Individual
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Provider Name | ELIZABETH M. CRUZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 840 W IRVING PARK RD STE 206
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City | CHICAGO
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State | IL
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Zip | 60613-3011
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Country | US
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Telephone | 773-975-6825
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Fax | 773-404-0713
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Provider Business Mailing Address
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Address Line | 818 LEYDEN LN
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City | WILMETTE
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State | IL
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Zip | 60091-2159
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Country | US
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Telephone | 847-853-7981
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Fax | 773-404-0713
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036085454
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License Number State | IL
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