Provider Demographics
NPI:1578622809
Name:SABBAGHA, ELIAS R (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:R
Last Name:SABBAGHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N. LAKE SHORE DR.
Mailing Address - Street 2:SUITE 1424
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-482-8484
Mailing Address - Fax:312-482-9977
Practice Address - Street 1:680 N. LAKE SHORE DR.
Practice Address - Street 2:SUITE 1424
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-482-8484
Practice Address - Fax:312-482-9977
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-076140174400000X, 207V00000X
IL336-039433207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist