Provider Demographics
NPI:1295001907
Name:PARKER, ELLEN THERESE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:THERESE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:THERESE
Other - Last Name:KLOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7005 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1001
Mailing Address - Country:US
Mailing Address - Phone:708-327-1410
Mailing Address - Fax:708-383-8932
Practice Address - Street 1:300 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2377
Practice Address - Country:US
Practice Address - Phone:708-327-7030
Practice Address - Fax:630-833-8834
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036137516208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics