Provider Demographics
NPI:1003835331
Name:ELLIGAN, DON GREGORY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:GREGORY
Last Name:ELLIGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N WABASH AVE
Mailing Address - Street 2:1610
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-2406
Mailing Address - Country:US
Mailing Address - Phone:312-925-2919
Mailing Address - Fax:312-235-0828
Practice Address - Street 1:203 N WABASH AVE
Practice Address - Street 2:1610
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-2406
Practice Address - Country:US
Practice Address - Phone:312-925-2919
Practice Address - Fax:312-235-0828
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7442103TC0700X
IN20041825A103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
202538Medicare ID - Type Unspecified