Provider Demographics
NPI:1598484024
Name:KALIL, ELYSE JESSIE
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:JESSIE
Last Name:KALIL
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 1:343 W WOLF POINT PLZ UNIT 1612
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-0103
Mailing Address - Country:US
Mailing Address - Phone:248-499-0514
Mailing Address - Fax:
Practice Address - Street 1:343 W WOLF POINT PLZ UNIT 1612
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-0103
Practice Address - Country:US
Practice Address - Phone:248-499-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.498351163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine