Provider Demographics
NPI:1669659298
Name:ELIAS, HELENE B (PA)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:B
Last Name:ELIAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W 156TH ST
Mailing Address - Street 2:STE 210
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4260
Mailing Address - Country:US
Mailing Address - Phone:708-596-2064
Mailing Address - Fax:708-596-1119
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:STE 210
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-596-2064
Practice Address - Fax:708-596-1119
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201290Medicare PIN