MEDICARE: ELIZABETH T KALLIATH DMD PC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1972450138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH T KALLIATH DMD PC

Provider Business Mailing Address
First Line	:	3037 N SEMINARY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4335
Country	:	US
Telephone Number	:	256-810-1987
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N WABASH AVE STE 1820
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-2973
Country	:	US
Telephone Number	:	312-236-3633
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	ELIZABETH KALLIATH
Credential	:	DMD
Telephone Number	:	256-810-1987

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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