Provider Demographics
NPI:1740210772
Name:PAHL, ELFRIEDE (MD)
Entity Type:Individual
Prefix:
First Name:ELFRIEDE
Middle Name:
Last Name:PAHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CHILDRENS PLAZA MAILBOX 21
Mailing Address - Street 2:CHILDRENS MEMORIAL HOSPITAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3394
Mailing Address - Country:US
Mailing Address - Phone:773-880-6388
Mailing Address - Fax:773-880-8111
Practice Address - Street 1:2300 CHILDRENS PLAZA BOX 21
Practice Address - Street 2:CHILDRENS MEMORIAL HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3394
Practice Address - Country:US
Practice Address - Phone:773-880-6388
Practice Address - Fax:773-880-8111
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360700392080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070039Medicaid
ILL56224Medicare ID - Type Unspecified
B41531Medicare UPIN