MEDICARE: DR. ELISA M SPRADLIN M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L-0503	TX
2	207Q00000X	Family Medicine Physician	E-1889	AR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P00126582	OTHER		RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5K950	OTHER	AR	BLUE CROSS/BLUE SHIELD
2	6576964003	OTHER		CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7976182	OTHER		AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	04070022700	OTHER	AR	QUALCHOICE
10	2015989	OTHER	AR	UNITED HEALTHCARE

NPI Number	:	1730183443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISA M SPRADLIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	479-431-3500
Fax Number	:	479-452-2098

Provider Business Practice Location Address
First Line	:	7003 CHAD COLLEY BLVD
Second Line	:
City	:	BARLING
State	:	AR
Zip	:	72923-3000
Country	:	US
Telephone Number	:	479-431-3500
Fax Number	:	479-452-2098

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/29/2025

LOTE 18 METRO OFFICE PARK , 3RD FLOOR SUITE 3000 AMERICAN HEALTH MEDICARE BUILDING
GUAYNABO, PR
00968

Practice Phone: 787-620-1919
Practice Fax: 787-620-0570