=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336039585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELKE LIMITED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2025
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5719 N MOBILE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646-6123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-674-2374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5719 N MOBILE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646-6123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-674-2374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. DANIEL ELKE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 630-674-2374
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------