Provider Demographics
NPI:1518078880
Name:HERNANDEZ-OUTLY, ELSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:
Last Name:HERNANDEZ-OUTLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 MARKET ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4643
Mailing Address - Country:US
Mailing Address - Phone:847-813-0700
Mailing Address - Fax:847-813-0795
Practice Address - Street 1:1460 MARKET ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4643
Practice Address - Country:US
Practice Address - Phone:847-813-0700
Practice Address - Fax:847-813-0795
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-077185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE21759Medicare UPIN