Provider Demographics
NPI:1366487688
Name:BERMAN, ELVINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELVINA
Middle Name:
Last Name:BERMAN
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 1:31480 N US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-9444
Mailing Address - Country:US
Mailing Address - Phone:847-680-2715
Mailing Address - Fax:847-680-3832
Practice Address - Street 1:31480 N US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9444
Practice Address - Country:US
Practice Address - Phone:847-680-2715
Practice Address - Fax:847-680-3832
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL344330Medicare ID - Type Unspecified