MEDICARE: DR. ELIZABETH MARIE DAMSTETTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	036139876	IL

General Provider Information

NPI Number	:	1184935611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH MARIE DAMSTETTER M.D.

Provider Business Mailing Address
First Line	:	2350 RAVINE WAY STE 400
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-7621
Country	:	US
Telephone Number	:	474-002-5428
Fax Number	:	847-221-6935

Provider Business Practice Location Address
First Line	:	2350 RAVINE WAY STE 400
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-7621
Country	:	US
Telephone Number	:	847-400-2542
Fax Number	:	847-221-6935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	09/07/2021

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