MEDICARE: MS. MARINA ELYASH PA-C

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	363AM0700X	Medical Physician Assistant		IL

General Provider Information

NPI Number	:	1982800306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARINA ELYASH PA-C

Provider Business Mailing Address
First Line	:	3537 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0035
Country	:	US
Telephone Number	:	708-786-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 W TOUHY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-2937
Country	:	US
Telephone Number	:	773-973-7350
Fax Number	:

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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