Provider Demographics
NPI:1740787290
Name:APOLLINARI, ELISABETTA
Entity Type:Individual
Prefix:
First Name:ELISABETTA
Middle Name:
Last Name:APOLLINARI
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 1:523 BUCKTHORN LN
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-1315
Mailing Address - Country:US
Mailing Address - Phone:630-877-5197
Mailing Address - Fax:
Practice Address - Street 1:523 BUCKTHORN LN
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1315
Practice Address - Country:US
Practice Address - Phone:630-877-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty