MEDICARE: ALI ELROD RN

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	163W00000X	Registered Nurse	041413424	IL

General Provider Information

NPI Number	:	1194658302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI ELROD RN

Provider Business Mailing Address
First Line	:	297 HASTINGS AVE
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-5157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2605
Country	:	US
Telephone Number	:	312-227-2800
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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