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NPI Code Detail

MEDICARE: MYLAUN ELAINE BLACKWELL MD

MEDICARE: MYLAUN ELAINE BLACKWELL MD
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
1207R00000XInternal Medicine Physician1841993102IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1841993102
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYLAUN ELAINE BLACKWELL MD
Provider Business Mailing Address
First Line : 9831 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-1740
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9831 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-1740
Country : US
Telephone Number : 773-445-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2023
Last Update Date : 06/16/2026

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Directions to “ MYLAUN ELAINE BLACKWELL MD” Practice Location

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