Provider Demographics
NPI:1053308676
Name:ACKERMANN, EVELYN S (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:S
Last Name:ACKERMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 CAPITAL STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-7837
Mailing Address - Country:US
Mailing Address - Phone:847-888-2020
Mailing Address - Fax:847-888-0652
Practice Address - Street 1:1670 CAPITAL STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-7837
Practice Address - Country:US
Practice Address - Phone:847-888-2020
Practice Address - Fax:847-888-0652
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077512207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077512Medicaid
ILL30589Medicare PIN
IL180018535Medicare PIN
IL036077512Medicaid