Provider Demographics
NPI:1043264252
Name:LELIS, ELIGIJUS P (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIGIJUS
Middle Name:P
Last Name:LELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 N 129TH INFANTRY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3103
Mailing Address - Country:US
Mailing Address - Phone:815-729-3777
Mailing Address - Fax:815-725-9358
Practice Address - Street 1:963 N 129TH INFANTRY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3103
Practice Address - Country:US
Practice Address - Phone:815-729-3777
Practice Address - Fax:815-725-9358
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077101207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000991581OtherBLUE CROSS BLUE SHIELD
IL180018594OtherRETIRED RAILROAD MEDICARE
IL036077101Medicaid
IL180018592OtherRETIRED RAILROAD MEDICARE
IL00099129581OtherBLUE CROSS BLUE SHIELD IL
ILCG9902OtherRETIRED RAILROAD MEDICARE
IL180018592OtherRETIRED RAILROAD MEDICARE
IL00099129581OtherBLUE CROSS BLUE SHIELD IL
ILK17607Medicare PIN
IL0857370001Medicare NSC
IL1780710780Medicare NSC
ILK17606Medicare PIN
IL0857370002Medicare NSC
ILK17605Medicare PIN