Provider Demographics
NPI:1336485861
Name:ELGIN MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ELGIN MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-742-4111
Mailing Address - Street 1:1975 LIN LOR LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4902
Mailing Address - Country:US
Mailing Address - Phone:847-742-4111
Mailing Address - Fax:847-742-4545
Practice Address - Street 1:1975 LIN LOR LN
Practice Address - Street 2:SUITE 205
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4902
Practice Address - Country:US
Practice Address - Phone:847-742-4111
Practice Address - Fax:847-742-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty