Provider Demographics
NPI:1275534471
Name:GOZUM, ELENA G (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:G
Last Name:GOZUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:54 W COUNTRYSIDE PARKWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560
Mailing Address - Country:US
Mailing Address - Phone:630-553-6262
Mailing Address - Fax:630-553-6450
Practice Address - Street 1:54 W COUNTRYSIDE PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560
Practice Address - Country:US
Practice Address - Phone:630-553-6262
Practice Address - Fax:630-553-6450
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104554207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H59554Medicare UPIN
ILK36365Medicare ID - Type Unspecified