Provider Demographics
NPI:1376672212
Name:ALEKSANDROVICH, ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:ALEKSANDROVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:STEPANENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-2953
Mailing Address - Country:US
Mailing Address - Phone:847-390-5922
Mailing Address - Fax:
Practice Address - Street 1:1775 BALLARD RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1005
Practice Address - Country:US
Practice Address - Phone:847-318-2500
Practice Address - Fax:847-318-2558
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPENDING207R00000X
IL036-118999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118999Medicaid
IL0163557OtherBLUE CROSS/BLUE SHIELD
214627Medicare PIN