Provider Demographics
NPI:1477184562
Name:CHICAGO NOSE AND SINUS LLC
Entity Type:Organization
Organization Name:CHICAGO NOSE AND SINUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELANGOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-689-4770
Mailing Address - Street 1:2549 WAUKEGAN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1569
Mailing Address - Country:US
Mailing Address - Phone:708-689-4770
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 1425
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4451
Practice Address - Country:US
Practice Address - Phone:312-480-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty