Provider Demographics
NPI:1225123698
Name:STROW, M ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:M ELIZABETH
Middle Name:
Last Name:STROW
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 1:2041 W ILES AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7005
Mailing Address - Country:US
Mailing Address - Phone:217-793-5517
Mailing Address - Fax:217-793-6187
Practice Address - Street 1:2041 W ILES SUITE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704
Practice Address - Country:US
Practice Address - Phone:217-793-5517
Practice Address - Fax:217-793-6187
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-072746174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL177007OtherHEALTHLINK
IL779860OtherMEDICARE PTAN
IL08415079OtherBLUE CROSS/BLUE SHIELD
IL37-1294960OtherTAX ID #
IL036-072746OtherIL LICENSE #
IL036072746Medicaid
IL116435OtherPERSONAL CARE
IL116435OtherPERSONAL CARE
IL779860OtherMEDICARE PTAN