Provider Demographics
NPI:1407245939
Name:COLDREN, ELAINE
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:COLDREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 N KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4420
Mailing Address - Country:US
Mailing Address - Phone:312-666-3494
Mailing Address - Fax:312-666-6628
Practice Address - Street 1:4747 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:312-666-3494
Practice Address - Fax:312-666-6628
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03.6145569208000000X
IL036145569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics